1659762524 NPI number — PANTHERX SPECIALTY LLC

Table of content: (NPI 1659762524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659762524 NPI number — PANTHERX SPECIALTY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANTHERX SPECIALTY 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:
1659762524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 BAYER RD BLDG 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15205-9706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-726-8479
Provider Business Mailing Address Fax Number:
855-246-3986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 SUMMIT PARK DR STE 101
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:
15275-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-726-8479
Provider Business Practice Location Address Fax Number:
855-246-3986
Provider Enumeration Date:
02/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SNYDER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
855-726-8479

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PP482247 , 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: 110105692A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659762524 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 382281901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4772202 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0484733 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659762524 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659762524 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250630465 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q044073 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003572 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659762524 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3535998 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500745115 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 089545 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026461101 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115359800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200566670A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100031262 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179064 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300005702 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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