NPIViewer - Provider NPI 1962406850

NPI:	1962406850
Name:	SPECIALTY THERAPEUTIC CARE LP
Entity type:	Organization
Organization Name:	SPECIALTY THERAPEUTIC CARE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:	JESSICA
Authorized Official - Middle Name:	DAWN
Authorized Official - Last Name:	CICCOLELLA-KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	800-511-5144
Mailing Address - Street 1:	PO BOX 956780
Mailing Address - Street 2:
Mailing Address - City:	SAINT LOUIS
Mailing Address - State:	MO
Mailing Address - Zip Code:	63195-6780
Mailing Address - Country:	US
Mailing Address - Phone:	855-422-2742
Mailing Address - Fax:	866-834-8523
Practice Address - Street 1:	1311 W SAM HOUSTON PKWY N STE 150
Practice Address - Street 2:
Practice Address - City:	HOUSTON
Practice Address - State:	TX
Practice Address - Zip Code:	77043
Practice Address - Country:	US
Practice Address - Phone:	866-506-2626
Practice Address - Fax:	866-834-8523
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2005-06-08
Last Update Date:	2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	251F00000X	Agencies	Home Infusion
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

State	Identifier ID	ID Type	Issuer
AK	1578774	Medicaid
ME	1962406850	Medicaid
ID	1962406850	Medicaid
TN	1962406850	Medicaid
OK	200096950A	Medicaid
IL	73169880001	Medicaid
	2097210	Other	PK
SC	7T4102	Medicaid
OH	0160873	Medicaid
ME	131430006	Medicaid
TX	148018	Medicaid
KY	7100232400	Medicaid
WY	WY0122	Medicaid
GA	003136712A	Medicaid
NV	10100264788-00	Medicaid
AR	192697407	Medicaid
NH	3094450	Medicaid
WA	6029680	Medicaid