1609960962 NPI number — ADAPTIVE TECHNOLOGIES, LLC

Table of content: (NPI 1609960962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609960962 NPI number — ADAPTIVE TECHNOLOGIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAPTIVE TECHNOLOGIES, 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:
1609960962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 WOODMONT BLVD.
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-550-8774
Provider Business Mailing Address Fax Number:
615-454-5352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2704 WOOTEN BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-291-5858
Provider Business Practice Location Address Fax Number:
252-291-5542
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRATOHVIL
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
615-550-8760

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7704336 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7795002 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7795259 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0414L . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7795310 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7795148 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7795214 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7795286 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7795129 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7702039 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7795074 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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