1457334153 NPI number — STREAMLINE TOTALCARE LLC

Table of content: (NPI 1457334153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457334153 NPI number — STREAMLINE TOTALCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STREAMLINE TOTALCARE 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:
THREE RIVERS INFUSION AND PHCY SPECIALISTS
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:
1457334153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1287
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSHOCTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43812-6287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-622-1175
Provider Business Mailing Address Fax Number:
740-622-0715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-622-1175
Provider Business Practice Location Address Fax Number:
740-622-0715
Provider Enumeration Date:
11/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VON BURG
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-622-1175

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  020517450 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3662081 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0782676 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".