1477553816 NPI number — JOHN P COONEY DO

Table of content: JOHN P COONEY DO (NPI 1477553816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477553816 NPI number — JOHN P COONEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COONEY
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1477553816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49443-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-727-5211
Provider Business Mailing Address Fax Number:
231-727-4571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2481 N 72ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HART
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-873-2163
Provider Business Practice Location Address Fax Number:
231-873-2143
Provider Enumeration Date:
07/28/2005

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: 207Q00000X , with the licence number:  5101012851 , 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: CJ0662 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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