1083778336 NPI number — RTA PEDIATRIC CARE INC

Table of content: (NPI 1083778336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083778336 NPI number — RTA PEDIATRIC CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RTA PEDIATRIC CARE INC
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:
FAMILY MEDICAL EQUIPMENT
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:
1083778336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 W LANDIS AVE UNIT 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-8114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-794-8050
Provider Business Mailing Address Fax Number:
856-794-8051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
882 S DELSEA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-4464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-697-8002
Provider Business Practice Location Address Fax Number:
856-697-8003
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
BART
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
856-794-8050

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  C0000038207 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0028461 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083778336 . This is a "COVENTRY DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 60036465 . This is a "HORIZON NEW JERSEY HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7035450 . This is a "AETNA NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0000293000 . This is a "IBC (KHPE, AMERI, PC,)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001886923 . This is a "HIGHMARK BC OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 10229233280001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083778336 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233089689 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 264419 . This is a "UNISON PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 40264419 . This is a "UNISON DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000293000 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 30047814 . This is a "KEYSTONE FIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 59637 . This is a "COVENTRY HEALTHCARE PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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