Provider Demographics
NPI:1649382235
Name:MEDICAL ARTS HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MEDICAL ARTS HEALTH CARE, LLC
Other - Org Name:OMNICARE OF ATLANTA #48233
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-765-1500
Mailing Address - Fax:
Practice Address - Street 1:594 SIGMAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1310
Practice Address - Country:US
Practice Address - Phone:770-922-9812
Practice Address - Fax:770-922-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0070983336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3721260001Medicaid
ME407740000Medicaid
GA00408273AMedicaid
WV6003127000Medicaid
NJ0054551Medicaid
DC035539900Medicaid
GA1135690OtherNCPDP
MD405520900Medicaid
SC3721260001Medicaid
3721260001Medicare NSC