1588630032 NPI number — ADHERERX INCORPORATED

Table of content: (NPI 1588630032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588630032 NPI number — ADHERERX INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADHERERX INCORPORATED
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:
1588630032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 MACKENAN DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-463-5555
Provider Business Mailing Address Fax Number:
919-465-5812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 MACKENAN DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-463-5555
Provider Business Practice Location Address Fax Number:
919-465-5812
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSE
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
CEO & PRESIDENT
Authorized Official Telephone Number:
615-346-0880

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  64001924A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHNR000198 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH26110 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 28267 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: Y006818 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 10895 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 28RO00096700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: NC1753 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P05499 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0000005794 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0214001646 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 032696 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 11467 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: NP000276 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0511382 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003122226A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7N8177 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 580128 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102692259 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 131766 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 332228900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0920567 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100287090 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201327340 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2069504 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 093397400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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