NPIMap

Organization Active NPI

Great Lakes in-Home Clinician Services Inc

  • Nurse Practitioner
  • Davison, MI
National Provider Identifier
1467696153
Registry record updated May 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
GREAT LAKES IN-HOME CLINICIAN SERVICES INC
Practice address
124 S State Rd
Davison, MI 48423-1347
Phone
(810) 664-7040
Fax
(810) 245-9080
NPI assigned
Apr 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2010

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

Authorized official

Name
Mrs. Kavita Suryavanshi, O.T.NPI 1396993168
Title
President
Phone
(810) 245-9400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

124 S State Rd
Davison, MI 48423-1347

Mailing address

404 W Nepessing St
Lapeer, MI 48446-2150
Phone (810) 664-7040

Other names 1

  • Elite Medical Services, Inc. Doing business as

National Provider Directory

National Provider Directory

Locations

4250 N Saginaw St
Flint, MI 48505
Phone (810) 785-1121

404 W Nepessing St
Lapeer, MI 48446
Phone (810) 245-9400

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274400000000",
    "number": "1467696153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W NEPESSING ST",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "484462150",
            "telephone_number": "810-664-7040",
            "fax_number": "810-245-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 S STATE RD",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231347",
            "telephone_number": "810-664-7040",
            "fax_number": "810-245-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES IN-HOME CLINICIAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2010-05-21",
        "status": "A",
        "authorized_official_last_name": "SURYAVANSHI",
        "authorized_official_first_name": "KAVITA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-245-9400",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.T."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Medical Services, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davison, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; 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.