1114004082 NPI number — CCN AMERICA LP

Table of content: (NPI 1114004082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114004082 NPI number — CCN AMERICA LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CCN AMERICA LP
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:
COORDINATED CARE NETWORK PHARMACY
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:
1114004082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-349-6300
Provider Business Mailing Address Fax Number:
412-349-6311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PENN CENTER BLVD
Provider Second Line Business Practice Location Address:
STE 405
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15235-5511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-349-6337
Provider Business Practice Location Address Fax Number:
412-349-6311
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLLACK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CFO
Authorized Official Telephone Number:
412-349-6300

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  054.018830 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHNR000903 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: MO40001734 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PA1463 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 4388 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 114317 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 13674 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 264536 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 64001140A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2013028515 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 22-13060 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 92900 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301010585 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P07388 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: A9-0001443 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0235504 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1114004082 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2085919 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2016006960 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018103020001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2721540 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810008615 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1114004082 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100147740 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300012108 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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