1346208949 NPI number — ACCREDO HEALTH GROUP INC

Table of content: (NPI 1346208949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346208949 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:
1346208949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2025
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:
1620 CENTURY CENTER PKWY STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-8849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-385-3600
Provider Business Practice Location Address Fax Number:
888-302-1028
Provider Enumeration Date:
05/03/2006

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:
314-684-6750

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 3946 , registered in the state of TN ; 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: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 010234417 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158995407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21460 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4094506-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 927957 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113194005 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1346208949 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160980000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0578625 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1455112 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2487385 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: PH536TN , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0103012 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02718770 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 035891400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09824589 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806981800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0102997 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007777870023 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188488300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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