1831393354 NPI number — KROGER LIMITED PARTNERSHIP I

Table of content: (NPI 1831393354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831393354 NPI number — KROGER LIMITED PARTNERSHIP I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KROGER LIMITED PARTNERSHIP I
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:
SCOTTS PHARMACY J417
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:
1831393354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5960 CASTLEWAY WEST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-1977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-579-8434
Provider Business Mailing Address Fax Number:
317-579-8424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N WAYNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANGOLA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46703-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-624-3110
Provider Business Practice Location Address Fax Number:
260-624-3920
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MINEER
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERFACE MANAGER
Authorized Official Telephone Number:
513-387-7074

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  60006074A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200866230A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1561530 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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