1467597856 NPI number — THOMAS HARRISON PRICE

Table of content: (NPI 1467597856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467597856 NPI number — THOMAS HARRISON PRICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS HARRISON PRICE
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:
1467597856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
881 ALMA REAL DR
Provider Second Line Business Mailing Address:
STE 117
Provider Business Mailing Address City Name:
PACIFIC PALISADES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90272-3761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-454-6505
Provider Business Mailing Address Fax Number:
310-459-7352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
881 ALMA REAL DR
Provider Second Line Business Practice Location Address:
STE 117
Provider Business Practice Location Address City Name:
PACIFIC PALISADES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90272-3761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-454-6505
Provider Business Practice Location Address Fax Number:
310-459-7352
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
RPH AND OWNER
Authorized Official Telephone Number:
310-454-6505

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY44886 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA448860 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0575211 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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