Provider Demographics
NPI:1982452371
Name:MAHARRY, JOE-SETH
Entity Type:Individual
Prefix:
First Name:JOE-SETH
Middle Name:
Last Name:MAHARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-9645
Mailing Address - Country:US
Mailing Address - Phone:616-255-5146
Mailing Address - Fax:
Practice Address - Street 1:317 SMITH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9645
Practice Address - Country:US
Practice Address - Phone:616-255-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM600425108030343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)