1346373065 NPI number — HASTINGS ORTHOPEDIC CLINIC PC

Table of content: (NPI 1346373065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346373065 NPI number — HASTINGS ORTHOPEDIC CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HASTINGS ORTHOPEDIC CLINIC 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:
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:
1346373065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 COOK RD
Provider Second Line Business Mailing Address:
PO BOX 290
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49058-9616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-945-9520
Provider Business Mailing Address Fax Number:
269-945-3368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 COOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49058-9616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-945-9520
Provider Business Practice Location Address Fax Number:
269-945-3368
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHELLENBARGER
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
269-945-4966

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  4301035154 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 5101012880 , 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: 5101013049 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 114206086 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5201000567 . This is a "SUE BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5101012880 . This is a "JLH BSBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5501012232 . This is a "JENNY BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101378087 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114316909 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200Z800130 . This is a "KSM BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5101013049 . This is a "ESL BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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