1275548612 NPI number — AIR AFFILIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275548612 NPI number — AIR AFFILIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIR AFFILIATES 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:
Provider Other Organization Name Type Code:
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:
1275548612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 90508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37209-0508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-460-0017
Provider Business Mailing Address Fax Number:
615-463-0107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JELLICO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37762-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-784-0988
Provider Business Practice Location Address Fax Number:
423-784-0986
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
615-460-0017

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0000000501 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 0000001805 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 22309 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0000000501 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90004185 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54005160 . This is a "FIRST HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000001226566 . This is a "CHA HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 040032400 . This is a "DOL DCMWC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 557723400 . This is a "DOL DCMWC PHARM" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 10293 . This is a "SUNBELT MEDICAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".