1366149643 NPI number — SYNERGY HEALTHCARE USA LLC

Table of content: (NPI 1366149643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366149643 NPI number — SYNERGY HEALTHCARE USA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNERGY HEALTHCARE USA 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:
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:
1366149643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1069
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28037-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-505-8401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 PICTON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44312-4270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-505-8401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
QUEEN
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
980-505-8401

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1066 . This is a "CLINIC/CENTER CORPORATE" identifier . This identifiers is of the category "OTHER".




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