1528119682 NPI number — WILLIAM F GOSS DC I PLLC

Table of content: (NPI 1528119682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528119682 NPI number — WILLIAM F GOSS DC I PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM F GOSS DC I PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOSS CHIROPRACTIC CLINICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528119682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 METROPOLITAN PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48310-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-264-2100
Provider Business Mailing Address Fax Number:
586-264-1117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 METROPOLITAN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48310-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-264-2100
Provider Business Practice Location Address Fax Number:
586-264-1117
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOSS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
586-264-2100

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G07169 . This is a "BCN GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 950E012410 . This is a "BCBS GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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