NPIMap

Organization Active NPI

Advanced Home Care Inc

  • Home Infusion Therapy Pharmacy
  • Kingsport, TN
National Provider Identifier
1215134309
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
License
000002963 Issued in TN
Legal business name
ADVANCED HOME CARE INC
Practice address
105 Jack White Dr
Kingsport, TN 37664
Phone
(423) 378-7330
Fax
(800) 311-7783
NPI assigned
Jul 2, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike Kalbaugh
Title
Credentialing Specialist
Phone
(336) 878-8824

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Home Infusion Therapy Pharmacy 3336H0001X 000002963 TN Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

105 Jack White Dr
Kingsport, TN 37664

Mailing address

PO Box 18049
Greensboro, NC 27419-8049
Phone (336) 878-8950

Other identifiers 2

IdentifierTypeStateIssuer
Q032329MedicaidTN
1215134309MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Advanced Home Care Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1215134309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18049",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274198049",
            "telephone_number": "336-878-8950",
            "fax_number": "336-878-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 JACK WHITE DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37664",
            "telephone_number": "423-378-7330",
            "fax_number": "800-311-7783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED HOME CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KALBAUGH",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "336-878-8824"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "TN",
            "license": "000002963",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q032329",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215134309",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.