1225239940 NPI number — ACCREDO HEALTH GROUP INC

Table of content: (NPI 1225239940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225239940 NPI number — ACCREDO HEALTH GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCREDO HEALTH GROUP 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:
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:
1225239940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 954041
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-381-7141
Provider Business Mailing Address Fax Number:
901-261-6924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4343 W ROYAL LN
Provider Second Line Business Practice Location Address:
STE 124
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75063-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-929-6800
Provider Business Practice Location Address Fax Number:
972-929-6945
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERINI
Authorized Official First Name:
VIC
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
314-684-6273

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  22254 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 151917501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2100272 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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