1578573960 NPI number — SHIAWASSEE ANESTHESIA SERVICES, P.C.

Table of content: (NPI 1578573960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578573960 NPI number — SHIAWASSEE ANESTHESIA SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIAWASSEE ANESTHESIA SERVICES, 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:
1578573960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWARTZ CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48473-0115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-635-7453
Provider Business Mailing Address Fax Number:
810-630-2151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 W KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWOSSO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48867-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-635-7453
Provider Business Practice Location Address Fax Number:
810-630-2151
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUWSMA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
810-635-7453

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  5101011005 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 5101008081 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 4301080892 , 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)





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