NPIMap

Organization Active NPI

Lake Huron OB GYN PLLC

  • Obstetrics & Gynecology Physician
  • Bad Axe, MI
National Provider Identifier
1013095173
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
NK013377 Issued in MI
Legal business name
LAKE HURON OB GYN PLLC
Practice address
1005 S Van Dyke Rd
Bad Axe, MI 48413-9614
Phone
(989) 269-3923
Fax
(989) 269-3983
NPI assigned
Nov 2, 2006
Last updated
Apr 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Authorized official

Name
Dr. Nancy Bischer Macchiarella, D.O.NPI 1912923970
Title
Owner
Phone
(989) 269-3923

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X NK013377 MI Primary

Addresses

Primary practice location

1005 S Van Dyke Rd
Bad Axe, MI 48413-9614

Mailing address

1005 S Van Dyke Rd
Bad Axe, MI 48413-9614
Phone (989) 269-3923

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nmacchiarella33143@direct.covenanthealthcare.com

National Provider Directory

National Provider Directory

Locations

1005 S Van Dyke Rd
Bad Axe, MI 48413
Phone (989) 269-3923

Interoperability endpoints

  • Direct secure messaging: nmacchiarella33143@direct.covenanthealthcare.com

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1013095173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 S VAN DYKE RD",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139614",
            "telephone_number": "989-269-3923",
            "fax_number": "989-269-3983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 S VAN DYKE RD",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139614",
            "telephone_number": "989-269-3923",
            "fax_number": "989-269-3983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HURON OB GYN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "MACCHIARELLA",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "BISCHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-269-3923",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "NK013377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nmacchiarella33143@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "1005 S Van Dyke Rd",
            "city": "Bad Axe",
            "state": "MI",
            "country_code": "US",
            "postal_code": "484139614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bad Axe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.