Provider Demographics
NPI:1194736587
Name:STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Entity type:Organization
Organization Name:STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GORDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-337-3048
Mailing Address - Street 1:1312 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1205
Mailing Address - Country:US
Mailing Address - Phone:269-337-3106
Mailing Address - Fax:269-337-3121
Practice Address - Street 1:1312 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1205
Practice Address - Country:US
Practice Address - Phone:269-337-3106
Practice Address - Fax:269-337-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260C976440OtherBC PROVIDER #
MI480C961160OtherBC PROVIDER #
MI010C976460OtherBC PROVIDER #
MI1954373Medicaid
MI480C961160OtherBC PROVIDER #
MI0C97644Medicare ID - Type Unspecified
MI1954373Medicaid
MI0C96116Medicare ID - Type Unspecified