1134115843 NPI number — DR. DENNIS J SPLAIN DO

Table of content: DR. DENNIS J SPLAIN DO (NPI 1134115843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134115843 NPI number — DR. DENNIS J SPLAIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPLAIN
Provider First Name:
DENNIS
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1134115843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 W CHEW ST
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:
18102-3406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-663-3441
Provider Business Mailing Address Fax Number:
610-663-3170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 W CHEW ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF DIAGNOSTIC RADIOLOGY
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-776-4822
Provider Business Practice Location Address Fax Number:
610-776-4671
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  OS003950L , 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)

  • Identifier: 109969 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20021129 . This is a "AMERIHEALTH MERCY NIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01566701 . This is a "CBC CREST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1090059 . This is a "AMERIHEALTH MERCY CREST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300034751 . This is a "RR MEDICARE CREST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0011749620001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011749620009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01566702 . This is a "CBC NIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 125484 . This is a "UNISON NIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 125483 . This is a "UNISON CREST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0040612000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300121491 . This is a "RR MEDICARE NIC" identifier . This identifiers is of the category "OTHER".




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