1730174616 NPI number — ANNE M BARR ENTERPRISES, LLC

Table of content: (NPI 1730174616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730174616 NPI number — ANNE M BARR ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNE M BARR ENTERPRISES, 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:
COUNTRYSIDE PHARMACY
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:
1730174616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64485-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-324-5111
Provider Business Mailing Address Fax Number:
816-324-5163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 E PRICE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64485-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-324-5111
Provider Business Practice Location Address Fax Number:
816-324-5163
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARR
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
816-324-5111

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 2001024920 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 870023629 . This is a "PALMETTO GBA - RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 625380902 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 353841901 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 353841919 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31124013 . This is a "BCBS DME" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 605380906 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2634144 . This is a "NCPDP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9004152 . This is a "WPS - MAC J5 PART B" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com