1144325556 NPI number — BYRAM HEALTHCARE CENTERS, INC

Table of content: (NPI 1144325556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144325556 NPI number — BYRAM HEALTHCARE CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYRAM HEALTHCARE CENTERS, 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:
BOWERMANS PHARMACY
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:
1144325556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 S WILLOW AVE
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93725-9349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-256-7988
Provider Business Mailing Address Fax Number:
866-514-2911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 S WILLOW AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93725-9349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-256-7988
Provider Business Practice Location Address Fax Number:
866-514-2911
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERNOCCHI
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
914-286-2000

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY49255 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA470430 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144325556 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0523402 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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