1811197593 NPI number — HASTINGS ORTHOPEDIC CLINIC

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 1811197593 NPI number — HASTINGS ORTHOPEDIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HASTINGS ORTHOPEDIC CLINIC
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:
1811197593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 COOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49058-9616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-945-4966
Provider Business Mailing Address Fax Number:
269-945-3368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 COOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49058-9616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-945-4966
Provider Business Practice Location Address Fax Number:
269-945-3368
Provider Enumeration Date:
07/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MERRIMAN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
269-945-4966

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101378087 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114206086 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205872959 . This is a "ESL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1881639839 . This is a "JLH NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200005744 . This is a "MCR RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540Z810220 . This is a "BCBS DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200044303 . This is a "MCR RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1346373065 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200Z800130 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 114316909 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467480152 . This is a "KSM NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1811197593 . This is a "HOC DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 250011404 . This is a "MCR RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 874704973 . This is a "MCD DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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