1679910269 NPI number — ATTICUS GROUP LLC

Table of content: (NPI 1679910269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679910269 NPI number — ATTICUS GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATTICUS GROUP 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:
VITAL CARE OF CENTRAL MISSISSIPPI
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:
1679910269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 FOUNTAINS BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39110-6344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-859-8200
Provider Business Mailing Address Fax Number:
601-859-1057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
276 NISSAN PKWY BLDG A
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39046-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
769-798-7748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HEGI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
769-798-7748

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  12242/2.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 12242/2.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 06155081 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 12242/2.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 12242/2.1 , registered in the state of MS ; 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: 06155081 . This is a "MEDICAID PHARMACY" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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