1679030530 NPI number — HEART AND VASCULAR INSTITUTE

Table of content: (NPI 1679030530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679030530 NPI number — HEART AND VASCULAR INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART AND VASCULAR INSTITUTE
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:
1679030530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22720 MICHIGAN AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124-2021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22720 MICHIGAN AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-791-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BEYDOUN
Authorized Official First Name:
HANADY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
313-993-7777

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1144341645 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11615581 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11892261 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12440670 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881916435 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932149838 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12063174 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12345659 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1912263914 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12151256 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417010315 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326291428 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962427260 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12091363 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12248863 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12718965 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1457687584 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043473382 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14396095 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1831154798 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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