1477571404 NPI number — CYSTIC FIBROSIS SERVICES LLC

Table of content: (NPI 1477571404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477571404 NPI number — CYSTIC FIBROSIS SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYSTIC FIBROSIS SERVICES 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:
1477571404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 E VOORHEES ST
Provider Second Line Business Mailing Address:
MS 790
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61834-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-709-2386
Provider Business Mailing Address Fax Number:
217-709-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10530 JOHN W ELLIOTT DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-541-4959
Provider Business Practice Location Address Fax Number:
866-574-1418
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PONCE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
847-527-2489

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X , with the licence number: 22618 , registered in the state of TX ; 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" .
  • Taxonomy code: 332B00000X , with the licence number: 22618 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 29801 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0072006850007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0510131 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028469 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477571404 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2041124 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500678751 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100798300D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1279595 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145295 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100443180B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477571404 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477571404 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477571404 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477571404 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21576777 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0105009 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 082243600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4528874 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0761528 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477571404 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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