NPIMap

Organization Active NPI

Board of Trustees of Michigan State University

Doing business as Michigan State University

  • Clinical Medical Laboratory
  • East Lansing, MI
National Provider Identifier
1629157979
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY
Doing business as
Michigan State University
Practice address
1355 Bogue Street
Room B123
East Lansing, MI 48824-6239
Phone
(517) 353-2032
Fax
(517) 432-3879
NPI assigned
Nov 6, 2006
Last updated
Apr 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

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

Authorized official

Name
Mrs. Lisa M Rucker
Title
Provider Enrollment Manager
Phone
(517) 355-8462

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

1355 Bogue Street
Room B123
East Lansing, MI 48824-6239

Mailing address

1355 Bogue Street
Room B123
East Lansing, MI 48824-6239
Phone (517) 353-2032

Other identifiers 1

IdentifierTypeStateIssuer
1881849MedicaidMI

Other names 1

  • Michigan State University Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000028 MI Part B Supplier - Independent Clinical Laboratory 3870405954 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: East Lansing, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Msu Dept of Urology23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

1355 Bogue St
Rm B12
East Lansing, MI 48824
Phone (517) 353-2030

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1629157979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 BOGUE STREET",
            "address_2": "ROOM B123",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488246239",
            "telephone_number": "517-353-2032",
            "fax_number": "517-432-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 BOGUE STREET",
            "address_2": "ROOM B123",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488246239",
            "telephone_number": "517-353-2032",
            "fax_number": "517-432-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "517-355-8462",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881849",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michigan State University",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.