Healthcare Provider Details

I. General information

NPI: 1619976446
Provider Name (Legal Business Name): IHS ACQUISITION XXX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CHELSEA PKWY
BOOTHWYN PA
19061-1305
US

IV. Provider business mailing address

3101 GAYLORD PKWY MAILSTOP 1E-E144
FRISCO TX
75034-8655
US

V. Phone/Fax

Practice location:
  • Phone: 800-400-9549
  • Fax: 469-365-8274
Mailing address:
  • Phone: 469-365-8129
  • Fax: 469-365-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP413902L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPP413902L
License Number StatePA

VIII. Authorized Official

Name: MRS. KELLY RATLIFF
Title or Position: PRESIDENT
Credential:
Phone: 469-365-8202