1205164647 NPI number — SOMERSET HEALTH SERVICES INC

Table of content: (NPI 1205164647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205164647 NPI number — SOMERSET HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMERSET HEALTH SERVICES INC
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:
SOMERSET PULMONARY MEDICINE
Provider Other Organization Name Type Code:
3
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:
1205164647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 645900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15264-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-443-5040
Provider Business Mailing Address Fax Number:
814-443-5697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 E CHURCH ST STE 3100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-1908
Provider Business Practice Location Address Fax Number:
814-443-9908
Provider Enumeration Date:
11/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RUSH
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-443-5221

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 710929 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CI6140 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015083500030 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002498582 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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