1396789590 NPI number — HEALTHCOM, INC

Table of content: (NPI 1396789590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396789590 NPI number — HEALTHCOM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCOM, 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:
THE NATIONAL ASSOC FOR HEALTHCARE COMM
Provider Other Organization Name Type Code:
4
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:
1396789590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 W JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULLIVAN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61951-1066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-728-8331
Provider Business Mailing Address Fax Number:
217-728-8961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 W JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULLIVAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61951-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-728-8331
Provider Business Practice Location Address Fax Number:
217-728-8961
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HYLANDER
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP QUALITY
Authorized Official Telephone Number:
855-206-5924

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0072496 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396789590 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396789590 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0704333 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30022937 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8166704 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com