1679917611 NPI number — ON-SITE RX

Table of content: (NPI 1679917611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679917611 NPI number — ON-SITE RX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON-SITE RX
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:
CPS HEARTBEATS WELLNESS CENTER-KNELLS RIDGE
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:
1679917611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 WASHINGTON ST NW
Provider Second Line Business Mailing Address:
STE. 101
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30501-3672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-532-1551
Provider Business Mailing Address Fax Number:
770-536-7519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
817 BOTETOURT CT
Provider Second Line Business Practice Location Address:
STE. 103
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-410-2775
Provider Business Practice Location Address Fax Number:
757-410-2790
Provider Enumeration Date:
04/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MCNEILLY
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
770-532-1551

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  0201004511 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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