1730127283 NPI number — NEW SCHRYVER LLC

Table of content: (NPI 1730127283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730127283 NPI number — NEW SCHRYVER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW SCHRYVER 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:
TRIDENTCARE
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:
1730127283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 RIDGEBROOK RD FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS GLENCOE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21152-9481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-662-4101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11585 E 53RD AVE STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80239-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-374-0073
Provider Business Practice Location Address Fax Number:
443-842-7264
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUOMO
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/CFO
Authorized Official Telephone Number:
8-786-8015

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  02-74852-0000 , registered in the state of CO ; 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: "Y" .

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

  • Identifier: 007399 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8200303 . This is a "EVERCARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 007399 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08002396 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 675808 . This is a "BLUE CROSS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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