1629173026 NPI number — JAMES M SHIRILLA MD PC

Table of content: MR. WILLIAM RALPH SCHMITT MD (NPI 1053386987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629173026 NPI number — JAMES M SHIRILLA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES M SHIRILLA MD PC
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:
1629173026
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:
109 W FLETCHER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPENA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49707-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-354-0845
Provider Business Mailing Address Fax Number:
989-354-2965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N DIVISION RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
PETOSKEY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49770-9045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-487-3980
Provider Business Practice Location Address Fax Number:
231-439-0278
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICKLES
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING OFFICE MANAGER
Authorized Official Telephone Number:
989-354-0845

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  JS036674 , 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: 1102428731 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4177153 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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