1801907944 NPI number — LANSING SURGICAL ASSOCIATES, P.L.L.C.

Table of content: (NPI 1801907944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801907944 NPI number — LANSING SURGICAL ASSOCIATES, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANSING SURGICAL ASSOCIATES, P.L.L.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:
1801907944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2720 S WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48910-2873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-487-8255
Provider Business Mailing Address Fax Number:
517-487-2059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48910-2873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-487-8255
Provider Business Practice Location Address Fax Number:
517-487-2059
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MARK
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-487-8255

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MJ010550 , 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: 4908848 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1020399 . This is a "MCLAREN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5331174 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0253311744 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000002185 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00397821 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com