1750533816 NPI number — HEMOPHILIA PREFERRED CARE OF MEMPHIS INC

Table of content: (NPI 1750533816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750533816 NPI number — HEMOPHILIA PREFERRED CARE OF MEMPHIS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMOPHILIA PREFERRED CARE OF MEMPHIS 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:
HEMOPHILIA PREFERRED CARE OF MEMPHIS
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:
1750533816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6423 SHELBY VIEW DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38134-7614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-757-9192
Provider Business Mailing Address Fax Number:
855-813-0583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6423 SHELBY VIEW DR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-757-9192
Provider Business Practice Location Address Fax Number:
855-813-0583
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RICHMAN
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CONTRACTS AND CREDENTIA
Authorized Official Telephone Number:
800-757-9192

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: 4559 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1750533816 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180365407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1041917270001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200530030A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1533122 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09928011 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181916741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 606504009 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750533816 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2117653 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 423097300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94005600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750533816 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100116400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721231 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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