1649589581 NPI number — SPECTRUM HEALTHCARE SOLUTIONS LLC

Table of content: (NPI 1649589581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649589581 NPI number — SPECTRUM HEALTHCARE SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM HEALTHCARE SOLUTIONS 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:
1649589581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3151 LENORA CHURCH RD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30039-4818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-344-0148
Provider Business Mailing Address Fax Number:
888-559-9575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3151 LENORA CHURCH RD
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30039-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-344-0148
Provider Business Practice Location Address Fax Number:
888-559-9575
Provider Enumeration Date:
09/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JEMISON
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
678-344-0148

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHRE009695 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1160376 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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