1558518795 NPI number — MEDNOW INFUSION, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558518795 NPI number — MEDNOW INFUSION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDNOW INFUSION, 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:
OPTION CARE
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:
1558518795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4222 PAYSPHERE CIR
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:
60674-0042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-879-6137
Provider Business Mailing Address Fax Number:
847-332-0298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 S. INDUSTRY WAY
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-3559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-884-0669
Provider Business Practice Location Address Fax Number:
208-884-4976
Provider Enumeration Date:
08/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CFO
Authorized Official Telephone Number:
800-879-6137

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; 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: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; 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" .

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

  • Identifier: 808178400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 808187200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1308192 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 270961 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270960 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500615025 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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