1639349566 NPI number — ACS PRODUCTS, INC.

Table of content: (NPI 1639349566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639349566 NPI number — ACS PRODUCTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACS PRODUCTS, 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:
Provider Other Organization Name Type Code:
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:
1639349566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 WILLIAMS STREET, NW
Provider Second Line Business Mailing Address:
TLC PROGRAM MANAGER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-929-6989
Provider Business Mailing Address Fax Number:
404-327-6404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3016 GEORGIA ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISIANA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63353-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-754-5511
Provider Business Practice Location Address Fax Number:
573-754-3933
Provider Enumeration Date:
03/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MICKLE
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CFO
Authorized Official Telephone Number:
404-329-7984

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4826-04 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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