1629898010 NPI number — BYRD HEALTH CARE

Table of content: (NPI 1629898010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629898010 NPI number — BYRD HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYRD HEALTH CARE
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:
1629898010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23077 GREENFILED RD
Provider Second Line Business Mailing Address:
STE 255
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-559-5200
Provider Business Mailing Address Fax Number:
248-449-6889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23077 GREENFILED RD
Provider Second Line Business Practice Location Address:
STE 255
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-559-5200
Provider Business Practice Location Address Fax Number:
248-449-6889
Provider Enumeration Date:
10/11/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
BERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-531-9521

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1336637651 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com