1962463075 NPI number — PATIENT SUPPORT SERVICES, INC

Table of content: (NPI 1962463075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962463075 NPI number — PATIENT SUPPORT SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT SUPPORT 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'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:
1962463075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19387 US HIGHWAY 19 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33764-3102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-284-2006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3706 SUMMERHILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-838-4881
Provider Business Practice Location Address Fax Number:
903-832-7264
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARTHY
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
727-530-7700

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 0064969 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0946998-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582207 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 628689200 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100814340A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145059716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0946998-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0946998-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0946998-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115091733 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1437026 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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