1336257179 NPI number — APPLECARE LLC

Table of content: (NPI 1336257179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336257179 NPI number — APPLECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLECARE 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:
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:
1336257179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 MALL BLVD
Provider Second Line Business Mailing Address:
SUITE 202E
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31406-4862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-349-4945
Provider Business Mailing Address Fax Number:
912-349-4105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 GLYNCO PKWY
Provider Second Line Business Practice Location Address:
BUILDING 1, SUITE 10
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31525-7921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-264-9111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PATIENT SERVICES MANAGER
Authorized Official Telephone Number:
912-349-4945

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GRP6575 . This is a "MEDICARE PTAN NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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