1962565895 NPI number — BROWNS PROFESSIONAL SERV INC

Table of content: (NPI 1962565895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962565895 NPI number — BROWNS PROFESSIONAL SERV INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWNS PROFESSIONAL SERV 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:
ADVANCED CARE PHARMACY SERVICES
Provider Other Organization Name Type Code:
3
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:
1962565895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 W GANSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49202-4063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-789-8980
Provider Business Mailing Address Fax Number:
517-750-2181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2136 ROBINSON RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49203-3557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-750-2180
Provider Business Practice Location Address Fax Number:
517-750-2181
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
GRANT
Authorized Official Middle Name:
HAROLD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
517-789-8980

Provider Taxonomy Codes

  • Taxonomy code: 163WD0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 23925 , 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: 1962565895 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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