1023539459 NPI number — UPSCALE HEALTHCARE, LLC

Table of content: (NPI 1023539459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023539459 NPI number — UPSCALE HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPSCALE HEALTHCARE, 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:
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:
1023539459
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:
5905 AIRWAYS BLVD APT 1604
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHAVEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38671-1853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-671-4610
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5905 AIRWAYS BLVD APT 1604
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-671-4610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GETER
Authorized Official First Name:
JAKEYA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
662-671-4610

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  333889 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 333889 . This is a "LPN LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com