1740390202 NPI number — CORAM ALTERNATE SITE SERVICES INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740390202 NPI number — CORAM ALTERNATE SITE SERVICES INC

Employer Identification Number (EIN):

Provider Organization Name:

CORAM ALTERNATE SITE SERVICES INC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1740390202

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/09/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 809160

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CHICAGO

Provider Business Mailing Address State Name:

IL

Provider Business Mailing Address Postal Code:

60680-9160

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

303-672-8631

Provider Business Mailing Address Fax Number:

303-298-0047

Provider First Line Business Practice Location Address:

1905-A KRAMER LANE

Provider Second Line Business Practice Location Address:

SUITE 500

Provider Business Practice Location Address City Name:

AUSTIN

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

78758-6299

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

512-338-9600

Provider Business Practice Location Address Fax Number:

512-338-0713

Provider Enumeration Date:

08/30/2006

Authorized Official Last Name:

WEINERT

Authorized Official First Name:

CRAIG

Authorized Official Middle Name:

S

Authorized Official Title or Position:

PRESIDENT

Authorized Official Telephone Number:

401-765-1500

• Taxonomy code: 251E00000X , with the licence number:  003655 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251F00000X , with the licence number: 003655 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QI0500X , with the licence number: 003655 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332BP3500X , with the licence number: 16602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 333600000X , with the licence number: 16602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 3336C0003X , with the licence number: 16602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 3336M0002X , with the licence number: 16602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 3336H0001X , with the licence number: 16602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 4595279 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
• Identifier: 16602 . This is a "RX LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".