1386674067 NPI number — CORAM ALTERNATE SITE SERVICES INC

Table of content: (NPI 1386674067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386674067 NPI number — CORAM ALTERNATE SITE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORAM ALTERNATE SITE SERVICES 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:
CORAM CVS/SPECIALTY INFUSION SERVICES
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:
1386674067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 809160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60680-9160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-895-3211
Provider Business Mailing Address Fax Number:
303-298-0047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 WATERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENDOTA HEIGHTS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55120-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-452-5600
Provider Business Practice Location Address Fax Number:
651-452-6510
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINERT
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-765-1500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 261268-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 261268-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 261268-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 261268-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0002X , with the licence number: 261268-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2421662 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 261268-7 . This is a "RX LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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