1598747362 NPI number — ODYSSEY HEALTHCARE OPERATING B LP

Table of content: (NPI 1598747362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598747362 NPI number — ODYSSEY HEALTHCARE OPERATING B LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODYSSEY HEALTHCARE OPERATING B LP
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:
ODYSSEY HEALTHCARE OF HUNTSVILLE
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:
1598747362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/23/2008
NPI Reactivation Date:
07/17/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
717 N HARWOOD ST
Provider Second Line Business Mailing Address:
SUITE 1500
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75201-6519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-922-9711
Provider Business Mailing Address Fax Number:
214-922-9752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2745 BOB WALLACE AVE SW
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35805-4158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-532-5199
Provider Business Practice Location Address Fax Number:
256-532-0293
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALLISON
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
DIRK
Authorized Official Title or Position:
SR VP & CFO
Authorized Official Telephone Number:
214-922-9711

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  11277 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PIC1611E , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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