1396714101 NPI number — LIFECARE MEDICAL TRANSPORTS, LLC

Table of content: DR. JEREMIAH DANIEL THOMPSON PT DPT (NPI 1700300878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396714101 NPI number — LIFECARE MEDICAL TRANSPORTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECARE MEDICAL TRANSPORTS, 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:
1396714101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7152
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60197-7152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-597-4911
Provider Business Mailing Address Fax Number:
866-687-2796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1170 INTERNATIONAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22406-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-752-7721
Provider Business Practice Location Address Fax Number:
540-752-5194
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JEWELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF REVENUE INTEGRATION OFFICER
Authorized Official Telephone Number:
844-597-4911

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  00749 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020215 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009010068 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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