1356335756 NPI number — NURSEMED LLC

Table of content: (NPI 1356335756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356335756 NPI number — NURSEMED LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURSEMED 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:
NURSEMED 1 AND NURSEMED 2
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:
1356335756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
716 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIPLEY
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38663-2909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-837-1534
Provider Business Mailing Address Fax Number:
662-837-3274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38663-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-837-1534
Provider Business Practice Location Address Fax Number:
662-837-3274
Provider Enumeration Date:
08/31/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-837-1534

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  R622176 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 258972 . This is a "PARTA - RURAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253865 . This is a "PARTA -RURAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09013704 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".