1740689579 NPI number — TURNTABLE HEALTH

Table of content: (NPI 1740689579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740689579 NPI number — TURNTABLE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TURNTABLE HEALTH
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:
1740689579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 TREMONT STREET 6TH FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA- MASSACHUSETTS
Provider Business Mailing Address Postal Code:
02108
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
617-454-4672
Provider Business Mailing Address Fax Number:
617-701-7740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 E BRIDGER AVE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89101-5554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-749-1515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FERNANDOPULLE
Authorized Official First Name:
RUSHIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
617-454-4672

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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