1760801963 NPI number — MEDLINE INDUSTRIES, LP

Table of content: (NPI 1760801963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760801963 NPI number — MEDLINE INDUSTRIES, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDLINE INDUSTRIES, LP
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:
MEDLINE INDUSTRIES, INC.
Provider Other Organization Name Type Code:
4
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:
1760801963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 LAKES DR.
Provider Second Line Business Mailing Address:
ATTN: HOMECARE COMPLIANCE
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60093-2753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-265-6512
Provider Business Mailing Address Fax Number:
866-779-5827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDLINE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75172-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-356-4997
Provider Business Practice Location Address Fax Number:
866-202-1563
Provider Enumeration Date:
04/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POCKLINGTON
Authorized Official First Name:
ZACH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SVP HOMECARE AND MANAGED CARE
Authorized Official Telephone Number:
844-265-6512

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1000243 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3587834-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".