Healthcare Provider Details

I. General information

NPI: 1972962470
Provider Name (Legal Business Name): REM NATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COURT ST SUITE 101A
WEST BRANCH MI
48661-8820
US

IV. Provider business mailing address

611 COURT ST STE 101A
WEST BRANCH MI
48661-8820
US

V. Phone/Fax

Practice location:
  • Phone: 855-276-2111
  • Fax:
Mailing address:
  • Phone: 855-276-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number4301073336
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THEODORE BASH
Title or Position: PRESIDENT
Credential: DO
Phone: 855-276-2111