1518901396 NPI number — TAPESTRY CONCEPTS, LLC

Table of content: (NPI 1518901396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518901396 NPI number — TAPESTRY CONCEPTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAPESTRY CONCEPTS, 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:
1518901396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2723 SUMMER OAKS DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTLETT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38134-2858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-312-3608
Provider Business Mailing Address Fax Number:
901-322-3496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2723 SUMMER OAKS DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTLETT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-2858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-312-3608
Provider Business Practice Location Address Fax Number:
901-322-3496
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ULLERY
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-312-3608

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  105002502 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 807416800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1455016 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06993111 . This is a "MEDICAL EQUIP SUPPLY PERM" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1015492490001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200808490A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2643778 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1777146 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9061607 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE2727 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010268443 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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