1538204169 NPI number — ONCOLOGY & HEMATOLOGY PC

Table of content: (NPI 1538204169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538204169 NPI number — ONCOLOGY & HEMATOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONCOLOGY & HEMATOLOGY PC
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:
Provider Other Organization Name Type Code:
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:
1538204169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5010 GULL RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048-1093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-226-8800
Provider Business Mailing Address Fax Number:
269-226-8804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5010 GULL RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49048-1093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-226-8800
Provider Business Practice Location Address Fax Number:
269-226-8804
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
269-226-8800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4310041932 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110102734 . This is a "MEDICARE ID TYPE UNSPECIF" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11-0C97609-0 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1338976 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG2125 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 36-30007 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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