1720357908 NPI number — FFP ACQUISITION II, LLC

Table of content: (NPI 1720357908)

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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