1801210463 NPI number — CHRISTINA AUSTIN WHITE DPT

Table of content: CHRISTINA AUSTIN WHITE DPT (NPI 1801210463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801210463 NPI number — CHRISTINA AUSTIN WHITE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
CHRISTINA
Provider Middle Name:
AUSTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALDEZ
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
AUSTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801210463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4466 W BRISTOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-733-1200
Provider Business Mailing Address Fax Number:
810-733-3130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 S COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-538-0600
Provider Business Practice Location Address Fax Number:
810-538-0602
Provider Enumeration Date:
02/18/2014

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: 225100000X , with the licence number:  5501016680 , 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: 0B52045 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1801210463 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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