1457339228 NPI number — TRI-UNITY INFUSION SERVICES, LLC

Table of content: (NPI 1457339228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457339228 NPI number — TRI-UNITY INFUSION SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-UNITY INFUSION SERVICES, 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:
TRI-UNITY PHARMACY
Provider Other Organization Name Type Code:
5
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:
1457339228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2061 W CONCORD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60647-6197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-996-0976
Provider Business Mailing Address Fax Number:
800-883-6613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 S WHITTAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BUFFALO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-214-4446
Provider Business Practice Location Address Fax Number:
800-886-1521
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARRETT
Authorized Official First Name:
DEVIN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
844-214-4446

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 5301008165 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 054.021028 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2469-43 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 64002718A . This is a "PHARMACY LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 5301008165 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4750671 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y007882 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1457339228 . This is a "BLUECROSS BLUESHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 266602 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2367363 . This is a "MEDIMPACT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2367363 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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