1750314035 NPI number — DR. LINDA SAMBORN DO

Table of content: DR. LINDA SAMBORN DO (NPI 1750314035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750314035 NPI number — DR. LINDA SAMBORN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMBORN
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1750314035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 WOODSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESSEXVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48732-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-892-7722
Provider Business Mailing Address Fax Number:
989-892-7455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4175 N EUCLID AVE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706-2483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-667-0491
Provider Business Practice Location Address Fax Number:
989-667-0493
Provider Enumeration Date:
07/09/2006

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: 207Q00000X , with the licence number:  5101011227 , 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: 0Z91029 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1007493 . This is a "MCLAREN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 233873 . This is a "RIVERBEND" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4983950 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: AF09001 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: LS011227 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 010Z911030 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 233866 . This is a "RIVERBEND" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P43930 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 010Z960170 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F51019 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4279897 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4303974 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4601967 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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