1992344949 NPI number — ZACHARY RUSSELL SMRCINA ATC

Table of content: ZACHARY RUSSELL SMRCINA ATC (NPI 1992344949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992344949 NPI number — ZACHARY RUSSELL SMRCINA ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMRCINA
Provider First Name:
ZACHARY
Provider Middle Name:
RUSSELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

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:
1992344949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30516
Provider Second Line Business Mailing Address:
DEPT 5300
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-294-4050
Provider Business Mailing Address Fax Number:
631-760-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9028 N RODGERS DR
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
CALEDONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-891-0600
Provider Business Practice Location Address Fax Number:
616-965-2475
Provider Enumeration Date:
12/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501303437 , 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)





Copyright © 2007-2025 www.npivalidator.com