Provider Demographics
NPI:1548489065
Name:MONTCALM CENTER FOR ORTHOPEDIC EXCELLENCE PC
Entity type:Organization
Organization Name:MONTCALM CENTER FOR ORTHOPEDIC EXCELLENCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-780-5038
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-0737
Mailing Address - Country:US
Mailing Address - Phone:616-780-5038
Mailing Address - Fax:888-592-7204
Practice Address - Street 1:500 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9775
Practice Address - Country:US
Practice Address - Phone:616-780-5038
Practice Address - Fax:888-592-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011651207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E90117OtherBCBS
MIMI8978Medicare PIN
MIOP16020Medicare UPIN