Basic Information
| Provider Information | |||||||||
| NPI: | 1811191307 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERITA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6912 S QUENTIN ST STE 50 | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801124531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202825325 | ||||||||
| FaxNumber: | 8776760493 | ||||||||
| Practice Location | |||||||||
| Address1: | 5959 SHALLOWFORD RD | ||||||||
| Address2: | SUITE #107 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238939335 | ||||||||
| FaxNumber: | 4238939336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | IRIYE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7202822377 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 0000002083 | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | 2083 | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 3336S0011X | 2083 | TN | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336H0001X | 2083 | TN | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 0000002083 | 01 | TN | BOARD OF PHARMACY | OTHER | FP0286371 | 01 | DEA | OTHER | 4423492 | 01 | TN | NCPDP | OTHER | 1452932 | 05 | TN | MEDICAID |