1588604078 NPI number — AEROCARE PHARMACY, INC.

Table of content: MR. SAMUEL THOMAS HUTTON PTA (NPI 1255778023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588604078 NPI number — AEROCARE PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AEROCARE PHARMACY, 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:
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:
1588604078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-249-3700
Provider Business Mailing Address Fax Number:
970-497-8415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15401 VANTAGE PKWY W
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77032-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-590-8933
Provider Business Practice Location Address Fax Number:
281-590-8552
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRIGGS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-206-0040

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X , with the licence number: 20910 , 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: 200014910A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08306701 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142576101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1975669 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010049458 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145107 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54005863 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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