1063562627 NPI number — EMPICARE, INC.

Table of content: (NPI 1063562627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063562627 NPI number — EMPICARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPICARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063562627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11802 BRINLEY AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-1089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-244-2774
Provider Business Mailing Address Fax Number:
502-244-8085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 DUBLIN RD
Provider Second Line Business Practice Location Address:
SUITE 110E #A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-487-8807
Provider Business Practice Location Address Fax Number:
614-487-8655
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRASK
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VP, CORPORATE DEVELOPMENT
Authorized Official Telephone Number:
502-244-2774

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  25-305965 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , with the licence number: 25-305965 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2557639 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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