1538138466 NPI number — THERAPEUTIC INNOVATIONS

Table of content: (NPI 1538138466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538138466 NPI number — THERAPEUTIC INNOVATIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC INNOVATIONS
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:
TI WOUNDCARE
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:
1538138466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-776-1890
Provider Business Mailing Address Fax Number:
540-776-8061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 COMMONWEALTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24018-5160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-776-1890
Provider Business Practice Location Address Fax Number:
540-776-8061
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TURMAN
Authorized Official First Name:
TRACIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
REIMBURSEMENT MANAGER
Authorized Official Telephone Number:
540-776-1890

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  13073 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4294543 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM0349 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23582731 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7703035 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 242215 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4581718 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440320 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1711070 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9106219 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0115888 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90172669 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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