1063661585 NPI number — PRIMARY CARE ASSOCIATES OF CARLISLE

Table of content: (NPI 1063661585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063661585 NPI number — PRIMARY CARE ASSOCIATES OF CARLISLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE ASSOCIATES OF CARLISLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063661585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 WALNUT BOTTOM RD
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-960-0052
Provider Business Mailing Address Fax Number:
717-960-0055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 WALNUT BOTTOM RD
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-960-0052
Provider Business Practice Location Address Fax Number:
717-960-0055
Provider Enumeration Date:
09/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
717-960-0052

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  0S009023L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com