MEDICARE: SHARON RUBICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	4704088816 1878905	MI
2	171M00000X	Case Manager/Care Coordinator	4704088816 1879905	MI
3	163WP0000X	Pain Management Registered Nurse	4704088816RN	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OF10335	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386700318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON RUBICK

Provider Business Mailing Address
First Line	:	2411 LAKE AVE
Second Line	:	#21
City	:	NORTH MUSKEGON
State	:	MI
Zip	:	49445
Country	:	US
Telephone Number	:	616-813-2679
Fax Number	:	231-719-2809

Provider Business Practice Location Address
First Line	:	2411 LAKE AVE
Second Line	:	#21
City	:	NORTH MUSKEGON
State	:	MI
Zip	:	49445
Country	:	US
Telephone Number	:	616-813-2679
Fax Number	:	231-719-2809

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MRS. SHARON ANN RUBICK
Credential	:	RN
Telephone Number	:	616-813-2679

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/14/2008

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Directions to “SHARON RUBICK ” Practice Location

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