1578568036 NPI number — PROFESSIONAL EMERGENCY CARE, P.C.

Table of content: (NPI 1578568036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578568036 NPI number — PROFESSIONAL EMERGENCY CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL EMERGENCY CARE, P.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:
1578568036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38935 ANN ARBOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48150-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-632-0175
Provider Business Mailing Address Fax Number:
888-861-8740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18101 OAKWOOD BLVD
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICINE DEPARTMENT
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-4089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-593-8780
Provider Business Practice Location Address Fax Number:
888-861-8740
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAUER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
734-632-0175

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , 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)

  • Identifier: 700D410740 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1578568036 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010Q262940 . This is a "BCBSMI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700E014610 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: CC0535 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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