1831555309 NPI number — RXVIP LLC

Table of content: (NPI 1831555309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831555309 NPI number — RXVIP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RXVIP 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:
1831555309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70434-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-605-0265
Provider Business Mailing Address Fax Number:
985-249-6823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2190 MANTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-605-0265
Provider Business Practice Location Address Fax Number:
985-249-6823
Provider Enumeration Date:
01/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PARKINS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER, AO
Authorized Official Telephone Number:
985-605-0265

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY.007283-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2157584 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com