1093834020 NPI number — PURFOODS, LLC

Table of content: (NPI 1093834020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093834020 NPI number — PURFOODS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURFOODS, 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:
6
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:
1093834020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3210 SE CORPORATE WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANKENY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50021-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-963-0641
Provider Business Mailing Address Fax Number:
515-266-6120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3210 SE CORPORATE WOODS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANKENY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50021-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-963-0641
Provider Business Practice Location Address Fax Number:
515-266-6120
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SVP SALES & BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
866-716-3257

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332U00000X , with the licence number: 0196501 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100292728 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2772316 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: EX0951 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00705268 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127458900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200629550A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250524302 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 274676 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30015057200002 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 086462000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39839 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6050138 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: H445168 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: S500410290 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003105053A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019650 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102383905-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800401 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88807550 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200925420A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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