Provider Demographics
NPI:1841255239
Name:RHEUMATOLOGY PC
Entity type:Organization
Organization Name:RHEUMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SUPER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-4307
Mailing Address - Street 1:2889 SOUTH 11TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2123
Mailing Address - Country:US
Mailing Address - Phone:269-343-4307
Mailing Address - Fax:269-343-6661
Practice Address - Street 1:2889 SOUTH 11TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2123
Practice Address - Country:US
Practice Address - Phone:269-343-4307
Practice Address - Fax:269-343-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0C96066Medicare ID - Type Unspecified