1861518979 NPI number — RITA P ECKENRODE MD

Table of content: (NPI 1861518979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861518979 NPI number — RITA P ECKENRODE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RITA P ECKENRODE MD
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:
1861518979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 S HURON PKWY
Provider Second Line Business Mailing Address:
STE 3C
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48104-5133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-973-7203
Provider Business Mailing Address Fax Number:
734-973-7204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 S HURON PKWY
Provider Second Line Business Practice Location Address:
STE 3C
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-973-7204
Provider Business Practice Location Address Fax Number:
734-973-7204
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ECKENRODE
Authorized Official First Name:
RITA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-973-7203

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , 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: 2941057 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1608142061 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2393503004 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C5442 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com