ACHTERHOF HEALTHCARE PHARMACY, LLC (MANAGED HEALTHCARE PHARMACY) - NPI NUMBER 1225022841

Summary

Provider Name: ACHTERHOF HEALTHCARE PHARMACY, LLC (MANAGED HEALTHCARE PHARMACY)

NPI Number: 1225022841

Clasification: Durable Medical Equipment & Medical Supplies (332B00000X)

Address:
1750 WILLOW CREEK CIR
EUGENE, OR
ZIP 97402

Phone Number: (541) 744-1641



Detailed Information

ACHTERHOF HEALTHCARE PHARMACY, LLC is a durable medical equipment & medical supplies in Eugene, OR. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient�s use in the home and that are usable for an extended period of time. The assigned NPI number for this provider is 1225022841 and is registered as an organization entity type.
The provider Is Doing Business As Managed Healthcare Pharmacy.

The provider's business address is:

1750 WILLOW CREEK CIR
EUGENE, OR
ZIP 97402-152
Phone: (541) 744-1641

The provider's authorized official is Randall Scott Klemm .
The authorized official title is Operations Manager and has the following contact phone number (541) 744-1641.

The enumeration date for this NPI number is 9/9/2005 and was last updated on 7/26/2013.

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 332B00000X Durable Medical Equipment & Medical Supplies 001218 OR No
2 333600000X Pharmacy 001218 OR 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 181400 MEDICAID OR
2 R130865 MEDICARE PIN OR
3 181401 MEDICAID OR
4 4563140001 MEDICARE NSC OR

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1225022841 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 ACHTERHOF HEALTHCARE PHARMACY, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name MANAGED HEALTHCARE 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 1750 WILLOW CREEK CIR 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 Business Practice Location Address City Name EUGENE The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name OR The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 974029152 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 5417441641 The telephone number associated with the location address of the provider being identified.
13 Provider Enumeration Date 9/9/2005 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 7/26/2013 The date that a record was last updated or changed.
15 Authorized Official Last Name KLEMM The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name RANDALL The first name of the authorized official.
17 Authorized Official Middle Name SCOTT The middle name of the authorized official.
18 Authorized Official Title or Position OPERATIONS MANAGER The title or position of the authorized official.
19 Authorized Official Telephone Number 5417441641 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 332B00000X 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.
21 Provider License Number 1 001218 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’’.
22 Provider License Number State Code 1 OR 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.
23 Healthcare Provider Primary Taxonomy Switch 1 N
24 Healthcare Provider Taxonomy Code 2 333600000X
25 Provider License Number 2 001218 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’’.
26 Provider License Number State Code 2 OR 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.
27 Healthcare Provider Primary Taxonomy Switch 2 Y
28 Other Provider Identifier 1 181400 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.
29 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.
30 Other Provider Identifier State 1 OR
31 Other Provider Identifier 2 R130865 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.
32 Other Provider Identifier Type Code 2 08 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.
33 Other Provider Identifier State 2 OR
34 Other Provider Identifier 3 181401 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 OR
37 Other Provider Identifier 4 4563140001 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 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.
39 Other Provider Identifier State 4 OR
40 Is Organization Subpart N
41 Authorized Official Credential Text RPH

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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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