1649541384 NPI number — AMERITA, INC.

Table of content: (NPI 1649541384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649541384 NPI number — AMERITA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERITA, 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:
OPTIONONE INFUSION
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:
1649541384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6912 S QUENTIN ST STE 50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-282-5325
Provider Business Mailing Address Fax Number:
855-623-2194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14000 N PORTLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73134-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-548-4848
Provider Business Practice Location Address Fax Number:
405-418-4442
Provider Enumeration Date:
01/25/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IRIYE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-407-0655

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  HC7986 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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