1952581340 NPI number — BONNY LOU OWENS ACCU- FIT COMPRESSION GARMENTS

Table of content: (NPI 1952581340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952581340 NPI number — BONNY LOU OWENS ACCU- FIT COMPRESSION GARMENTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BONNY LOU OWENS ACCU- FIT COMPRESSION GARMENTS
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:
ACCU FIT COMPRESSION GARMENTS
Provider Other Organization Name Type Code:
5
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:
1952581340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3260 WALDEN AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEPEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14043-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-444-7198
Provider Business Mailing Address Fax Number:
716-235-5898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3260 WALDEN AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEPEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14043-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-444-7198
Provider Business Practice Location Address Fax Number:
716-235-5898
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
BONNY
Authorized Official Middle Name:
LOU
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
716-444-7198

Provider Taxonomy Codes

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

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

  • Identifier: 00011281601 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8290310 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040401000147 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01482631 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551182001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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