Provider Demographics
NPI:1457334153
Name:STREAMLINE TOTALCARE LLC
Entity Type:Organization
Organization Name:STREAMLINE TOTALCARE LLC
Other - Org Name:THREE RIVERS INFUSION AND PHCY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:VON BURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-1175
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-6287
Mailing Address - Country:US
Mailing Address - Phone:740-622-1175
Mailing Address - Fax:740-622-0715
Practice Address - Street 1:238 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1507
Practice Address - Country:US
Practice Address - Phone:740-622-1175
Practice Address - Fax:740-622-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0205174503336H0001X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3662081OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH0782676Medicaid