1821097981 NPI number — MAUREEN C MEAD MD

Table of content: MAUREEN C MEAD MD (NPI 1821097981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821097981 NPI number — MAUREEN C MEAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEAD
Provider First Name:
MAUREEN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1821097981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 W WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPENA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49707-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-358-0673
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1185 US HIGHWAY 23 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPENA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49707-8004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-356-4049
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2005

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: 207PE0004X , with the licence number:  4301060807 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 4301060807 , 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: 3486833 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MM060807 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 930068267 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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