1558433136 NPI number — REHABILITATION ASSOCIATES OF MIDMICHIGAN P L C

Table of content: (NPI 1558433136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558433136 NPI number — REHABILITATION ASSOCIATES OF MIDMICHIGAN P L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION ASSOCIATES OF MIDMICHIGAN P L C
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:
1558433136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 W WACKERLY ST
Provider Second Line Business Mailing Address:
#3825
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48640-4722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-631-9267
Provider Business Mailing Address Fax Number:
989-839-0629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W WACKERLY ST
Provider Second Line Business Practice Location Address:
#3825
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48640-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-631-9267
Provider Business Practice Location Address Fax Number:
989-839-0629
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SZAJENKO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-631-9267

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , 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: 3383068 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4187893 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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