1609020304 NPI number — ACCESS WCP LLC

Table of content: (NPI 1609020304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609020304 NPI number — ACCESS WCP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS WCP 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:
1609020304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2173 MACDADE BLVD
Provider Second Line Business Mailing Address:
UNIT G AND J
Provider Business Mailing Address City Name:
HOLMES
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19043-1217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-494-0787
Provider Business Mailing Address Fax Number:
866-211-1416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2173 MACDADE BLVD
Provider Second Line Business Practice Location Address:
UNIT G AND J
Provider Business Practice Location Address City Name:
HOLMES
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19043-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-494-0787
Provider Business Practice Location Address Fax Number:
866-211-1416
Provider Enumeration Date:
11/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
O'BRIEN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
866-605-1001

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP481884 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3991331 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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