1720001845 NPI number — DEVON ELIZABETH BATTERSHELL MA, LLP

Table of content: DEVON ELIZABETH BATTERSHELL MA, LLP (NPI 1720001845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720001845 NPI number — DEVON ELIZABETH BATTERSHELL MA, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATTERSHELL
Provider First Name:
DEVON
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LLP
Provider Gender Code:
F

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:
1720001845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9557 TRACE HOLLOW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-3672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-635-6637
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4111 ANDOVER RD STE 150-W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-635-6637
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6301012082 , 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: 0911419 . This is a "BCBSM MESSA/MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5266701 . This is a "AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1705289 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028363 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 130958 . This is a "CARE CHOICES AND PREFERRE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 258694 . This is a "MHN PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 20530 . This is a "BCBSM SUBSTANCE ABUSE PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7509104190 . This is a "BCBSM MENTAL HEALTH PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1063603106 . This is a "HEALTH PLUS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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