Provider Demographics
NPI:1477574101
Name:FERRIS STATE UNIVERSITY
Entity Type:Organization
Organization Name:FERRIS STATE UNIVERSITY
Other - Org Name:UNIVERSITY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL RECORD INSURANCE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:231-591-3056
Mailing Address - Street 1:1310 CRAMER CIRCLE
Mailing Address - Street 2:PENNOCK 506
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2738
Mailing Address - Country:US
Mailing Address - Phone:231-591-2222
Mailing Address - Fax:231-591-3991
Practice Address - Street 1:1310 CRAMER CIRCLE
Practice Address - Street 2:PENNOCK 506
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2738
Practice Address - Country:US
Practice Address - Phone:231-591-2222
Practice Address - Fax:231-591-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3414290Medicaid
MI3414290Medicaid