Provider Demographics
NPI:1285604819
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:OJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-226-3576
Mailing Address - Street 1:425 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4521
Mailing Address - Country:US
Mailing Address - Phone:906-226-3576
Mailing Address - Fax:906-226-2380
Practice Address - Street 1:425 FISHER ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-226-3576
Practice Address - Fax:906-226-2380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-25
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI52-6160313M00000X
MI53010056043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI002286Medicaid
MI23-5494OtherMEDICARE PROVIDER #
MI23-5494OtherMEDICARE PROVIDER #
MI0E26015Medicare PIN