1548389836 NPI number — PREFERRED MOBILE NURSES, INC.

Table of content: (NPI 1548389836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548389836 NPI number — PREFERRED MOBILE NURSES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED MOBILE NURSES, 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:
PREFERRED HOME HEALTH; PREFERRED HOME CARE 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:
1548389836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2802 MADISON SQUARE DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-3396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-776-1970
Provider Business Mailing Address Fax Number:
970-776-1980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 MADISON SQUARE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80538-3396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-776-1970
Provider Business Practice Location Address Fax Number:
970-776-1980
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETTUS
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-263-1566

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 0403KK , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 1003RW , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 237581 . This is a "GENTIVA-CARE CENTRIX" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 05700810 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170348 . This is a "APRIA HEALTHCARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 672650 . This is a "BCBS-COLORADO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: AN91905740001 . This is a "CIGNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 70682241 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72650 . This is a "BCBS-FEDERAL" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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