1134175193 NPI number — LIFECARE PODIATRY, P.C.

Table of content: (NPI 1134175193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134175193 NPI number — LIFECARE PODIATRY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECARE PODIATRY, P.C.
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:
1134175193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 N ABERDEEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-293-9383
Provider Business Mailing Address Fax Number:
610-293-0409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 N ABERDEEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-293-9383
Provider Business Practice Location Address Fax Number:
610-293-0409
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-293-9383

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0015921020004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000426244 . This is a "FEDERAL BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: CF2898 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 426244 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0099575000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000021434 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18844 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000426244 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: LI426244 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1011348 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com