1225201932 NPI number — MEDCO AT HOME LLC

Table of content: (NPI 1225201932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225201932 NPI number — MEDCO AT HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDCO AT HOME 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:
1225201932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14811 N KIERLAND BLVD
Provider Second Line Business Mailing Address:
STE 100 RM 109
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-368-5005
Provider Business Mailing Address Fax Number:
480-368-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14811 N KIERLAND BLVD
Provider Second Line Business Practice Location Address:
STE 100 RM 109
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254-2729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-368-5005
Provider Business Practice Location Address Fax Number:
480-368-5040
Provider Enumeration Date:
04/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CANNONE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIORDIRECTOR, LICENSING
Authorized Official Telephone Number:
314-684-5075

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X , with the licence number: Y004924 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0355304 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com