1154755247 NPI number — DECILLION HEALTHCARE LLC

Table of content: (NPI 1154755247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154755247 NPI number — DECILLION HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECILLION HEALTHCARE 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:
BIOMATRIX SPECIALTY PHARMACY OH
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:
1154755247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 CRAMER CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-389-8371
Provider Business Mailing Address Fax Number:
614-367-1684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 CRAMER CREEK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-389-8371
Provider Business Practice Location Address Fax Number:
614-367-1684
Provider Enumeration Date:
08/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMM
Authorized Official First Name:
KATHEE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO, PRESIDENT, LLC MANAGER
Authorized Official Telephone Number:
954-385-7322

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PMY.022887700-03 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2141698 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0096398 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154755247 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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