1932129319 NPI number — ADVANCED PHYSICAL MEDICINE, P.C.

Table of content: (NPI 1932129319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932129319 NPI number — ADVANCED PHYSICAL MEDICINE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PHYSICAL MEDICINE, P.C.
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:
1932129319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24345 HARPER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLAIR SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48080-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-563-3300
Provider Business Mailing Address Fax Number:
586-563-3313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24345 HARPER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIR SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48080-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-563-3300
Provider Business Practice Location Address Fax Number:
586-563-3313
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
586-563-3300

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  SW061846 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: SW061846 , 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: QMXPR0031827 . This is a "MOLINA HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00000004300A . This is a "CAPE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 578264ADV . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 433225010 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116625 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1932129319 . This is a "DMENSION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 199589 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 131109 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2505012031 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540E019050 . This is a "BCBSM DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5614160001 . This is a "MC NSC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5112550 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7908612 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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