1952480220 NPI number — MICHIGAN STATE UNIVERSITY

Table of content: (NPI 1952480220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952480220 NPI number — MICHIGAN STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN STATE UNIVERSITY
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:
OLIN HEALTH CENTER DME
Provider Other Organization Name Type Code:
5
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:
1952480220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 SERVICE RD
Provider Second Line Business Mailing Address:
SUITE A202F
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48824-7015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-355-3503
Provider Business Mailing Address Fax Number:
517-432-3928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
463 E CIRCLE DR
Provider Second Line Business Practice Location Address:
OLIN HEALTH CENTER - DME
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-7500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-353-9165
Provider Business Practice Location Address Fax Number:
517-432-0709
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROMIG
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PROVIDER ENROLLMENT
Authorized Official Telephone Number:
517-884-2976

Provider Taxonomy Codes

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

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