Provider Demographics
NPI:1801128657
Name:MIDMICHIGAN NEUROPSYCHOLOGY ASSOCIATES, P.L.C.
Entity type:Organization
Organization Name:MIDMICHIGAN NEUROPSYCHOLOGY ASSOCIATES, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MACINNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-921-5100
Mailing Address - Street 1:4705 TOWNE CENTRE RD.
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2821
Mailing Address - Country:US
Mailing Address - Phone:989-921-5100
Mailing Address - Fax:989-921-5104
Practice Address - Street 1:4705 TOWNE CENTRE RD.
Practice Address - Street 2:SUITE 304
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2821
Practice Address - Country:US
Practice Address - Phone:989-921-5100
Practice Address - Fax:989-921-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008040103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIWM008040OtherBCBS
MIP93585OtherBLUE CARE NETWORK
MIWM008040OtherBCBS