Provider Demographics
NPI: | 1518081199 |
---|---|
Name: | MME PIRIE |
Entity Type: | Organization |
Organization Name: | MME PIRIE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | ROSA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BELLEVILLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 518-869-0400 |
Mailing Address - Street 1: | 1660 WESTERN AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBANY |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12203-4239 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-869-0400 |
Mailing Address - Fax: | 518-869-4862 |
Practice Address - Street 1: | 1660 WESTERN AVE |
Practice Address - Street 2: | |
Practice Address - City: | ALBANY |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12203-4239 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-869-0400 |
Practice Address - Fax: | 518-869-4862 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-19 |
Last Update Date: | 2007-12-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 335E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 0829780001 | Medicare NSC |