1194925818 NPI number — FLEMING THERAPY SERVICES, LLC

Table of content: (NPI 1194925818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194925818 NPI number — FLEMING THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLEMING THERAPY 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:
FLEMING THERAPY SERVICES INC
Provider Other Organization Name Type Code:
4
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:
1194925818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1311 MAMARONECK AVE STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10605-5224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-294-4050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2765 JEFFERSON DAVIS HWY
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22554-8331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-720-2261
Provider Business Practice Location Address Fax Number:
540-720-5660
Provider Enumeration Date:
07/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFITHS
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PAYER RELATIONS
Authorized Official Telephone Number:
914-294-4050

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305207330 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 0119006347 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2202004658 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 299916 . This is a "ANTHEM BLUE CROSS AND BLU" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 299917 . This is a "ANTHEM BLUE CROSS AND BLU" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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