1265427058 NPI number — FIRST CARE HEALTH PLLC

Table of content: (NPI 1265427058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265427058 NPI number — FIRST CARE HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CARE HEALTH PLLC
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:
ARCHER'S TOTAL HOME HEALTHCARE
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:
1265427058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 SWEETWATER VONORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWEETWATER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37874-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-337-5812
Provider Business Mailing Address Fax Number:
423-337-0453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 SWEETWATER VONORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEETWATER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37874-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-337-5812
Provider Business Practice Location Address Fax Number:
423-337-0453
Provider Enumeration Date:
09/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SATTERFIELD
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
423-337-5812

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  397 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 3686 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 397 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3686 . This is a "MANUFACTURER/WHOLESALER/DISTRIBUTOR - TN DEPT OF HEALTH - BOARD OF PHARMACY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 397 . This is a "HME LICENSE NUMBER - TN DEPT OF HEALTH - HEALTH CARE FACILITIES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4411574 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3545290 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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