Provider Demographics
NPI:1225141542
Name:ION HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:ION HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-241-7931
Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:STE 102
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1381
Mailing Address - Country:US
Mailing Address - Phone:201-261-1119
Mailing Address - Fax:201-261-1189
Practice Address - Street 1:452 OLD HOOK RD
Practice Address - Street 2:STE 102
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1391
Practice Address - Country:US
Practice Address - Phone:201-261-1119
Practice Address - Fax:201-261-1189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ION HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010272297Medicaid
VA423824OtherSOUTHERN HEALTH
VA352330OtherANTHEM
VA6113190001Medicare NSC