Panacea Portal LLC

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

PANACEA PORTAL LLC

Practice address

6457 Hickory LN
Burton, MI 48509-9303

Phone

(248) 509-4774

NPI assigned

Apr 20, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian RouseNPI 1609527142

Title

President

Phone

(248) 509-4774

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Rouse

  • Other Specialist/Technologist
  • Burton, MI
  • NPI 1609527142
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1003559675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6457 HICKORY LN",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485099303",
            "telephone_number": "248-509-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6457 HICKORY LN",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485099303",
            "telephone_number": "248-509-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANACEA PORTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-20",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "ROUSE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-509-4774"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Contractor in Burton, MI
• Providers in Burton, MI by specialty
• Contractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.