1144520420 NPI number — FAYETTE SPECIALTY ASSOCIATES

Table of content: (NPI 1144520420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144520420 NPI number — FAYETTE SPECIALTY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTE SPECIALTY ASSOCIATES
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:
1144520420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MATTHEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-8418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-434-1200
Provider Business Mailing Address Fax Number:
724-434-1600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 YOUNGSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LEMONT FURNACE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15456-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-434-1650
Provider Business Practice Location Address Fax Number:
724-434-1659
Provider Enumeration Date:
11/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ELKHOURY
Authorized Official First Name:
NABIL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN-DIRECTOR
Authorized Official Telephone Number:
724-434-1200

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD439306 , 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: 188053R6L . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com