1598823304 NPI number — LISA K STONE PA-C

Table of content: LISA K STONE PA-C (NPI 1598823304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598823304 NPI number — LISA K STONE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE
Provider First Name:
LISA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTIANSEN
Provider Other First Name:
LISA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598823304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 S BALLENGER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-922-9270
Provider Business Mailing Address Fax Number:
231-922-9271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 SOUTH DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-3255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-772-6821
Provider Business Practice Location Address Fax Number:
231-922-9271
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  5601004391 , 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: 1022872 MONITOR . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-373 . This is a "COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1022873 DRG . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "PRIORITY HEALTH OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-370 . This is a "COMMUNITY CHOICE/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1022871 RUFFIN . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-366 . This is a "COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-372 . This is a "COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-368 . This is a "COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1023384 BRIDGEPORT . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-369 . This is a "COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4549956 . This is a "MOLINA HEALTH CARE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1022696 JANES ST. . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 159123 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-367 . This is a "COMMUNITY CHOICE OF MICHIGAN/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328-371 . This is a "COMMUNITY CHOICE MICHIGAN/CARE SOURCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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