1275589830 NPI number — ACCREDO HEALTH GROUP INC

Table of content: (NPI 1275589830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275589830 NPI number — ACCREDO HEALTH GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCREDO HEALTH GROUP 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:
ACCREDO HEALTH GROUP INC
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:
1275589830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 954041
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-381-7141
Provider Business Mailing Address Fax Number:
901-261-6924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22623 68TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-1981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-872-2121
Provider Business Practice Location Address Fax Number:
253-872-5663
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERINI
Authorized Official First Name:
VIC
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
314-684-6273

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHAR.CF.00004193 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; 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: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5602639 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805937700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275589830 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170911 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6020218 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805943300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 230030 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006589 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2109525 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: PH193WA , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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