1346294303 NPI number — NORTHLAKE MEDICAL CENTER LLC

Table of content: (NPI 1346294303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346294303 NPI number — NORTHLAKE MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHLAKE MEDICAL CENTER 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:
1346294303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1455 MONTREAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCKER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30084-8100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-270-3000
Provider Business Mailing Address Fax Number:
770-270-3199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1455 MONTREAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084-8100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-270-3000
Provider Business Practice Location Address Fax Number:
770-270-3199
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SATTERFIELD
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
770-270-3010

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037132200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025106700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10809A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158331700 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 304783690 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: EMO0033N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200179210A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2543117 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000547A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1757811 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3119396 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 50004977 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 81479600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010110491 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3566 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 410333500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: OP10033 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2064377 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3026168 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 883448 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com