1720357908 NPI number — FFP ACQUISITION II, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720357908 NPI number — FFP ACQUISITION II, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FFP ACQUISITION II, LLC
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:
6
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:
1720357908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8024 STAGE HILLS BLVD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38133-4048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-380-5899
Provider Business Mailing Address Fax Number:
901-380-5877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8024 STAGE HILLS BLVD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38133-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-380-5899
Provider Business Practice Location Address Fax Number:
901-380-5877
Provider Enumeration Date:
12/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMM
Authorized Official First Name:
KATHEE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-385-7322

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  0000003956 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 0000003956 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 0000003956 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1027440 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720357908 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720357908 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7T395D , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1032174620001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152310001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720357908 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30015069190002 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720357908 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720357908 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600003610 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100208210 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 827817 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1531004 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 257909000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3090554 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40634337 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026547200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720357908 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200489400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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