1801906458 NPI number — MICHIGAN OMS P C

Table of content: (NPI 1801906458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801906458 NPI number — MICHIGAN OMS P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN OMS P C
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:
1801906458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6022 W MAPLE RD STE 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322-4408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-855-2006
Provider Business Mailing Address Fax Number:
248-855-0571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6022 W MAPLE RD STE 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-855-2006
Provider Business Practice Location Address Fax Number:
248-855-0571
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOURNIAS
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-228-9070

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , 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: 2901020355 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3159052 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4067429 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2990516 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2990561 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2773480 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 970F31085 . This is a "GROUP NUMBER BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: NB015573 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1021382 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3203473 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2990552 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com