1134115207 NPI number — CITY OF WARREN

Table of content: (NPI 1134115207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134115207 NPI number — CITY OF WARREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF WARREN
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:
1134115207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18105-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-473-2278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 W 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-2334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-723-2950
Provider Business Practice Location Address Fax Number:
814-723-3242
Provider Enumeration Date:
09/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PASCUZZI
Authorized Official First Name:
SANTO
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
FIRE CHIEF CITY OF WARRREN
Authorized Official Telephone Number:
814-723-2950

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0014089360003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043236 . This is a "AETNA USHC BLUE BELL HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50040817 . This is a "CAPITAL BLUE CROSS BASIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223998 . This is a "BC BS OF PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 833811 . This is a "UMWA HEALTH & RETIREMENT" identifier . This identifiers is of the category "OTHER".