1831190701 NPI number — MACOMB FAMILY SERVICES, INC.

Table of content: (NPI 1831190701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831190701 NPI number — MACOMB FAMILY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACOMB FAMILY SERVICES, INC.
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:
1831190701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36975 UTICA RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48036-1685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-226-3440
Provider Business Mailing Address Fax Number:
586-226-3672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36975 UTICA RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-1685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-226-3440
Provider Business Practice Location Address Fax Number:
586-226-3740
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PFAENDTNER
Authorized Official First Name:
OWEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
586-336-0422

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  N/A , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: N/A , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 125267 . This is a "VALUE OPTIONS PIN # - ALL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 20389 . This is a "BLUE CROSS S/A" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2066282 . This is a "ROMEO CIGNA PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2068754 . This is a "RICHMOND CIGNA PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910529 . This is a "ROMEO BLUE CROSS PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910671 . This is a "SHELBY BLUE CROSS PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 20531 . This is a "BLUE CROSS S/A" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3396315 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13305 . This is a "CLINTON CIGNA PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910710 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 20528 . This is a "BLUE CROSS S/A" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910612 . This is a "CLINTON BLUE CROSS PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M07925 . This is a "HAP PIN #- ALL SITES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 20572 . This is a "BLUE CROSS S/A" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910526 . This is a "RICHMOND BLUE CROSS PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 77353 . This is a "SHELBY CIGNA PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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