1174702203 NPI number — LEVIN FAMILY MEDICINE, LLC

Table of content: (NPI 1174702203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174702203 NPI number — LEVIN FAMILY MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEVIN FAMILY MEDICINE, LLC
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:
1174702203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
259 OLD ROUTE 30
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-6992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-216-9300
Provider Business Mailing Address Fax Number:
724-216-9302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
259 OLD ROUTE 30
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-216-9300
Provider Business Practice Location Address Fax Number:
724-216-9302
Provider Enumeration Date:
10/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVIN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-216-9300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 312560 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3723448 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 233445200 . This is a "INDEPENDENCE BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00442997 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 252235 . This is a "UPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1658189 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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