1780025288 NPI number — HILLMAN OPCO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780025288 NPI number — HILLMAN OPCO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLMAN OPCO LLC
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:
6
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:
1780025288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7400 NEW LA GRANGE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-4870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-429-8062
Provider Business Mailing Address Fax Number:
502-429-0650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 CARING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLMAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49746-8818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-742-4581
Provider Business Practice Location Address Fax Number:
989-742-3710
Provider Enumeration Date:
07/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
502-429-8062

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780025288 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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