1568730281 NPI number — EASTERN MICHIGAN UNIVERSITY

Table of content: (NPI 1568730281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568730281 NPI number — EASTERN MICHIGAN UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN MICHIGAN UNIVERSITY
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:
6
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:
1568730281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 CORNELL RD
Provider Second Line Business Mailing Address:
FLETCHER BUILDING, ACC MAIN OFFICE
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-1657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 CORNELL RD
Provider Second Line Business Practice Location Address:
FLETCHER BUILDING,
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-485-2890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KASTLE-RUETHER
Authorized Official First Name:
KRISTINE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
734-487-2890

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1780989020 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 23317193 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 1699070656 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 5201007984 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 1215113246 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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