1225518749 NPI number — NURSE TO GO, LLC.

Table of content: (NPI 1225518749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225518749 NPI number — NURSE TO GO, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURSE TO GO, LLC.
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:
NURSE TO GO
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:
1225518749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 PARKER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BYRAM
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39272-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-906-9680
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 PARKER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BYRAM
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39272-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-906-5081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
FLORA
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-906-9680

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WC0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WD0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0807X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WW0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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