1922110519 NPI number — PRIORITY HEALTH SERVICES INC.

Table of content: KATHERINE LEE LEMPICKI COTA (NPI 1063982379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922110519 NPI number — PRIORITY HEALTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY HEALTH 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:
1922110519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11455 E 13 MILE RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48093-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-979-2267
Provider Business Mailing Address Fax Number:
586-979-1185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11455 E 13 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-979-2267
Provider Business Practice Location Address Fax Number:
586-979-1185
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOUGH
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-979-2267

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119222 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 61308 . This is a "OMNI CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3288397 . This is a "MOLINA HEALTHCARE OF MICH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000003584 . This is a "CAPE MEDICAL HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 008524 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 21256 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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