1821159682 NPI number — TAKECARE INSURANCE CO, INC.

Table of content: (NPI 1821159682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821159682 NPI number — TAKECARE INSURANCE CO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAKECARE INSURANCE CO, 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'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:
1821159682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 6578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96931-6578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-646-6956
Provider Business Mailing Address Fax Number:
671-647-3556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OLEAL BUSINESS CENTER 1ST FLR.
Provider Second Line Business Practice Location Address:
STE. 108-112
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-235-1006
Provider Business Practice Location Address Fax Number:
671-647-3556
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNITZER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
671-646-5825

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP002 , registered in the state of MP ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302R00000X , with the licence number: 12137-0002 , registered in the state of MP ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5428950 . This is a "NCPDP #" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".
  • Identifier: 5428950 . This is a "NCPDP" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".




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