1497791420 NPI number — PCA OF COLUMBIA, INC.

Table of content: (NPI 1497791420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497791420 NPI number — PCA OF COLUMBIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PCA OF COLUMBIA, 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:
Provider Other Organization Name Type Code:
6
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:
1497791420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 HATCHER LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-388-0777
Provider Business Mailing Address Fax Number:
931-388-1548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1602 HATCHER LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-490-1000
Provider Business Practice Location Address Fax Number:
931-388-1548
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
931-388-0777

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X , with the licence number:  2030 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 2030 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X , with the licence number: 2030 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZI0100X , with the licence number: 2030 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0105X , with the licence number: 200241 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZC0500X , with the licence number: 2030 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3403473 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009801160 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1540854 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3790378800 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00789049A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00119533 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200412900A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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