1881665180 NPI number — AMMED DIRECT LLC

Table of content: (NPI 1881665180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881665180 NPI number — AMMED DIRECT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMMED DIRECT 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:
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:
1881665180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5720 CROSSINGS BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTIOCH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37013-3144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-941-3500
Provider Business Mailing Address Fax Number:
615-941-3822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5720 CROSSINGS BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTIOCH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37013-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-941-3500
Provider Business Practice Location Address Fax Number:
615-941-3822
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-941-3500

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000705 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06972708 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2440228 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 253505018A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00914325 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148472716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98183532 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4568254 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1139181 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200036550A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480038 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009120122 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000023876 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1617870-1 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6203062000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 626101703 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82263800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1454373 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90007964 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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