1306903158 NPI number — SPRINGVILLE PHARMACY INFUSION THERAPY, INC.

Table of content: (NPI 1306903158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306903158 NPI number — SPRINGVILLE PHARMACY INFUSION THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGVILLE PHARMACY INFUSION THERAPY, 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:
1306903158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4222 PAYSPHERE CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-0042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-879-6137
Provider Business Mailing Address Fax Number:
847-332-0298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 CENTRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-499-2168
Provider Business Practice Location Address Fax Number:
716-667-1401
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CFO
Authorized Official Telephone Number:
800-879-6137

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 023326 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 023326 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 023326 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 023326 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02395206 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1015248760001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3301316 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: BA0705 . This is a "MEDICARE B LOCAL" identifier . This identifiers is of the category "OTHER".




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