1669658563 NPI number — PREMIER PLASTIC SURGERY,P.C.,F.A.C.S.

Table of content: (NPI 1669658563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669658563 NPI number — PREMIER PLASTIC SURGERY,P.C.,F.A.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER PLASTIC SURGERY,P.C.,F.A.C.S.
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:
1669658563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1232
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48480-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-606-8200
Provider Business Mailing Address Fax Number:
810-606-8282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9450 S SAGINAW RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-8206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-606-8200
Provider Business Practice Location Address Fax Number:
810-606-8282
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MAKHENE
Authorized Official First Name:
RAMOTSUMI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PLASTIC SURGEON WITH HAND SPECIALTY
Authorized Official Telephone Number:
810-606-8200

Provider Taxonomy Codes

  • Taxonomy code: 2082S0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0986343 . This is a "HP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 50015979 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4250386 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C6904 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0250494 . This is a "BN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1001506 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0250494 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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