Provider Demographics
NPI:1548217789
Name:CONSOLIDATED CRITICAL CARE, INC.
Entity Type:Organization
Organization Name:CONSOLIDATED CRITICAL CARE, INC.
Other - Org Name:HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-699-5559
Mailing Address - Street 1:1035 RESEARCH CENTER ATLANTA DR SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2035
Mailing Address - Country:US
Mailing Address - Phone:404-699-5559
Mailing Address - Fax:404-699-5535
Practice Address - Street 1:1035 RESEARCH CENTER ATLANTA DR SW
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2035
Practice Address - Country:US
Practice Address - Phone:404-699-5559
Practice Address - Fax:404-699-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060172139332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000428667AMedicaid
GA0224050001Medicare ID - Type Unspecified