1285678490 NPI number — CENTRAL LINE INFUSION DALLAS DIVISION LTD

Table of content: (NPI 1285678490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285678490 NPI number — CENTRAL LINE INFUSION DALLAS DIVISION LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL LINE INFUSION DALLAS DIVISION LTD
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:
AMERITA
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:
1285678490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6912 S QUENTIN ST STE 50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-282-5325
Provider Business Mailing Address Fax Number:
877-676-0493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8080 TRISTAR DRIVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75063-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-815-0460
Provider Business Practice Location Address Fax Number:
972-915-3841
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SILOLAHTI
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP REVENUE CYCLE MANAGEMENT
Authorized Official Telephone Number:
720-282-2382

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  23275 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 23275 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 23275 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1285678490 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23275 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4531352 . This is a "NCPDP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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