CCN AMERICA LP (COORDINATED CARE NETWORK PHARMACY) - NPI NUMBER 1114004082

Summary

Provider Name: CCN AMERICA LP (COORDINATED CARE NETWORK PHARMACY)

NPI Number: 1114004082

Clasification: Pharmacy (333600000X)

Address:
300 PENN CENTER BLVD
STE 405
PITTSBURGH, PA
ZIP 15235

Phone Number: (412) 349-6337



Detailed Information

CCN AMERICA LP is a pharmacy in Pittsburgh, PA. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. The assigned NPI number for this provider is 1114004082 and is registered as an organization entity type.
The provider Is Doing Business As Coordinated Care Network Pharmacy.

The provider's business address is:

300 PENN CENTER BLVD
STE 405
PITTSBURGH, PA
ZIP 15235-511
Phone: (412) 349-6337
Fax: (412) 349-6311

The provider's authorized official is Thomas Pollack .
The authorized official title is Vp and has the following contact phone number (412) 349-6300.

The enumeration date for this NPI number is 10/31/2006 and was last updated on 5/21/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 333600000X Pharmacy No
2 332B00000X Durable Medical Equipment & Medical Supplies No
3 3336C0003X Pharmacy Community/Retail Pharmacy PP481123 PA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 0235504 MEDICAID NJ
2 5845900001 MEDICARE NSC
3 1018103020001 MEDICAID PA
4 7100147740 MEDICAID KY
5 2085919 OTHER PK
6 3810008615 MEDICAID WV
7 2721540 MEDICAID OH

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1114004082 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name CCN AMERICA LP The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name COORDINATED CARE NETWORK PHARMACY Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 300 PENN CENTER BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address STE 405 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name PITTSBURGH The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name PA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 152355511 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 4123496337 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 4123496311 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 10/31/2006 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 5/21/2014 The date that a record was last updated or changed.
17 Authorized Official Last Name POLLACK The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name THOMAS The first name of the authorized official.
19 Authorized Official Title or Position VP The title or position of the authorized official.
20 Authorized Official Telephone Number 4123496300 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 333600000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 332B00000X
24 Healthcare Provider Primary Taxonomy Switch 2 N
25 Healthcare Provider Taxonomy Code 3 3336C0003X
26 Provider License Number 3 PP481123 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
27 Provider License Number State Code 3 PA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
28 Healthcare Provider Primary Taxonomy Switch 3 Y
29 Other Provider Identifier 1 0235504 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 1 NJ
32 Other Provider Identifier 2 5845900001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier Type Code 2 07 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier 3 1018103020001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
36 Other Provider Identifier State 3 PA
37 Other Provider Identifier 4 7100147740 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier Type Code 4 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
39 Other Provider Identifier State 4 KY
40 Other Provider Identifier 5 2085919 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
41 Other Provider Identifier Type Code 5 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
42 Other Provider Identifier Issuer 5 PK
43 Other Provider Identifier 6 3810008615 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
44 Other Provider Identifier Type Code 6 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
45 Other Provider Identifier State 6 WV
46 Other Provider Identifier 7 2721540 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
47 Other Provider Identifier Type Code 7 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
48 Other Provider Identifier State 7 OH
49 Is Organization Subpart N

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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