1629288212 NPI number — MID-MICHIGAN PEDIATRICS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629288212 NPI number — MID-MICHIGAN PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-MICHIGAN PEDIATRICS 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:
1629288212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3272
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48605-3272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-797-1400
Provider Business Mailing Address Fax Number:
989-797-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HARROW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48638-6095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-921-5396
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-921-5396

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15359 . This is a "GREAT LAKES PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1008072 . This is a "MCLAREN PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C4761 . This is a "MCARE PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3507301902 . This is a "BCBS PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1062294 . This is a "HEALTHPLUS PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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