1861559619 NPI number — JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC

Table of content: (NPI 1861559619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861559619 NPI number — JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
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:
1861559619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1321 PINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALMA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48801-1242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-463-1139
Provider Business Mailing Address Fax Number:
989-466-2808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2865 S LINCOLN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-9085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-773-7747
Provider Business Practice Location Address Fax Number:
989-779-1068
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MIEDEMA
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
989-773-7747

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901003749 , 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: 900B910180 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com