1649383092 NPI number — LBITTEL

Table of content: (NPI 1649383092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649383092 NPI number — LBITTEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LBITTEL
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:
BEACON PRESCRIPTIONS
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:
1649383092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
294 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTED
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-738-2506
Provider Business Mailing Address Fax Number:
860-379-3876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
294 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTED
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-738-2506
Provider Business Practice Location Address Fax Number:
860-379-3876
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BITTEL
Authorized Official First Name:
LORI
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-559-4217

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PCY.0001719 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004127412 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008107659 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000252 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008106469 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004123634 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 332B00000X . This is a "DURABLE MEDICAL EQUIP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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