1497272694 NPI number — PHARMCARE USA OF LUBBOCK LLC

Table of content: JOSEPH AUSTIN MCKEE PT, DPT (NPI 1285402156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497272694 NPI number — PHARMCARE USA OF LUBBOCK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMCARE USA OF LUBBOCK 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:
PHARMCARE USA OF LUBBOCK
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:
1497272694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYDRO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73048-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-219-3619
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6102 45TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-219-3619
Provider Business Practice Location Address Fax Number:
877-505-7999
Provider Enumeration Date:
08/28/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOMERSALL
Authorized Official First Name:
DORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF COMPLIANCE
Authorized Official Telephone Number:
866-219-3619

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 31536 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 351065 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2169520 . This is a "PK" identifier . This identifiers is of the category "OTHER".