Basic Information
| Provider Information | |||||||||
| NPI: | 1649435579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ODYSSEY HEALTHCARE OPERATING A LP | ||||||||
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| OtherOrganizationName: | GENTIVA CARECONNECT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 FOSTER | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662132696 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 DONELSON PIKE | ||||||||
| Address2: | SUITE B5 | ||||||||
| City: | NASVHILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372173013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153651009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARTZ | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9138142288 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3373623 | 01 | MEDICARE PART B | OTHER |