1750843314 NPI number — PANTHERX SPECIALTY LLC

Table of content: (NPI 1750843314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750843314 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:
1750843314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 STEVENSON MILL RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAOPOLIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15108-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-246-9858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2019

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: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 085356 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750843314 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750843314 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250011129 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102702417-0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119479000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1707107 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750843314 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200566670B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300035017 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 065578648 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100032036 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026461102 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750843314 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2208349 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225998200 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250629322 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 308697407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3127541 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0410024 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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