1447242292 NPI number — MIGUN BODY SENSE

Table of content: (NPI 1447242292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447242292 NPI number — MIGUN BODY SENSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIGUN BODY SENSE
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:
1447242292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1614 19TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48708-7400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-893-9480
Provider Business Mailing Address Fax Number:
989-893-9481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48708-5718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-893-9480
Provider Business Practice Location Address Fax Number:
989-893-9481
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VANSICKLE
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-893-9480

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 54-0-29-1070-0 . This is a "BCBSN-MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com