1629585054 NPI number — PCMA PALLIATIVE DIVISION LLC

Table of content: (NPI 1629585054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629585054 NPI number — PCMA PALLIATIVE DIVISION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PCMA PALLIATIVE DIVISION 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:
1629585054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8526 SOUTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44514-3620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 CLIFFMINE RD STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15275-1053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
878-201-3312
Provider Business Practice Location Address Fax Number:
878-201-3584
Provider Enumeration Date:
01/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
THIMONS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
DO
Authorized Official Telephone Number:
724-766-0025

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00000000 . This is a "00000000" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 112077800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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