1093700205 NPI number — NIGHTINGALE ERS INC

Table of content: (NPI 1093700205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093700205 NPI number — NIGHTINGALE ERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIGHTINGALE ERS 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:
NIGHTINGALE DME
Provider Other Organization Name Type Code:
3
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:
1093700205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9100 WHITE BLUFF RD
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31406-4668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-354-3727
Provider Business Mailing Address Fax Number:
912-691-4716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 WHITE BLUFF RD
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-4668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-354-3727
Provider Business Practice Location Address Fax Number:
912-691-4716
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
912-355-6472

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000786002A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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