1841457314 NPI number — MIDMICHIGAN HEALTH SERVICES

Table of content: (NPI 1841457314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841457314 NPI number — MIDMICHIGAN HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDMICHIGAN HEALTH SERVICES
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:
6
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:
1841457314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9249 W LAKE CITY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUGHTON LAKE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48629-9602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-422-5122
Provider Business Mailing Address Fax Number:
989-422-6838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSCOMMON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48653-7658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-275-8931
Provider Business Practice Location Address Fax Number:
989-275-4074
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILNER
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
989-422-5148

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: 18010 . This is a "BCBSM FACILITY CODE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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