1043279789 NPI number — INTRAMED PLUS, INC.

Table of content: (NPI 1043279789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043279789 NPI number — INTRAMED PLUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTRAMED PLUS, 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:
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:
1043279789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4995 LACROSS RD
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-6542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-763-2080
Provider Business Mailing Address Fax Number:
803-763-9916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4995 LACROSS RD
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-6542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-763-2080
Provider Business Practice Location Address Fax Number:
803-763-9916
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, CF/TREASURER
Authorized Official Telephone Number:
800-879-6137

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  01061984165043 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4224743 . This is a "NCPDP/NABP PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 740306 . This is a "SC MEDICAID RX PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DE1142 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com