1437586641 NPI number — RELIANT RENAL CARE BESSEMER HOME CHOICE LLC

Table of content: (NPI 1437586641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437586641 NPI number — RELIANT RENAL CARE BESSEMER HOME CHOICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANT RENAL CARE BESSEMER HOME CHOICE 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:
RRC BESSEMER HOME
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:
1437586641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N PROVIDENCE RD
Provider Second Line Business Mailing Address:
BLD II SUITE 1040
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-2043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-892-4700
Provider Business Mailing Address Fax Number:
610-892-9760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 9TH AVE N.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BESSEMER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-892-4700
Provider Business Practice Location Address Fax Number:
610-892-9760
Provider Enumeration Date:
10/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MC MULLEN
Authorized Official First Name:
NOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
307-287-7640

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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