Provider Demographics
NPI:1124300553
Name:NAVY
Entity type:Organization
Organization Name:NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IDC
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SPARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-533-0552
Mailing Address - Street 1:6683 GAWLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8964
Mailing Address - Country:US
Mailing Address - Phone:810-533-0552
Mailing Address - Fax:
Practice Address - Street 1:6683 GAWLEY RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8964
Practice Address - Country:US
Practice Address - Phone:810-533-0552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital