1093768996 NPI number — AMERICAN MEDICAL HOME HEALTH SERVICES LLC

Table of content: (NPI 1093768996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093768996 NPI number — AMERICAN MEDICAL HOME HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN MEDICAL HOME HEALTH SERVICES 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:
AMERICAN MEDICAL HOME HEALTH SERVICES-MATHIS
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:
1093768996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 VALLEY BROOK ROAD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
MCMURRAY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-9610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-684-4550
Provider Business Mailing Address Fax Number:
724-684-5944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AMERICAN MEDICAL HOME HEALTH SERVICES
Provider Second Line Business Practice Location Address:
206 W. CORPUS CHRISTI ST.
Provider Business Practice Location Address City Name:
BEEVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-547-5655
Provider Business Practice Location Address Fax Number:
361-547-0304
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOJONOVIC
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER PRESIDENT
Authorized Official Telephone Number:
724-684-4550

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  007438 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1705600 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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