Provider Demographics
NPI:1881612398
Name:MIDMICHIGAN VISITING NURSE ASSOCIATION
Entity type:Organization
Organization Name:MIDMICHIGAN VISITING NURSE ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER PATIENT ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-633-5227
Mailing Address - Street 1:3007 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4555
Mailing Address - Country:US
Mailing Address - Phone:989-633-1400
Mailing Address - Fax:989-633-1464
Practice Address - Street 1:3007 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-633-1400
Practice Address - Fax:989-633-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI563510251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3010584 15Medicaid
MI08739OtherBLUE CROSS
MI3010584 15Medicaid