1972065043 NPI number — AXIVA INFUSION CENTERS - HT LLC

Table of content: (NPI 1972065043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972065043 NPI number — AXIVA INFUSION CENTERS - HT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AXIVA INFUSION CENTERS - HT 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:
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:
1972065043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 W TOWNSHIP LINE RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-4929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-601-0760
Provider Business Mailing Address Fax Number:
610-756-0670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010 W CHESTER PIKE STE 438
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-2740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-442-9482
Provider Business Practice Location Address Fax Number:
844-440-0101
Provider Enumeration Date:
04/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
844-442-9482

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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