1336273218 NPI number — RANDY R. SHEMER D.O. L.L.C.

Table of content: (NPI 1336273218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336273218 NPI number — RANDY R. SHEMER D.O. L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDY R. SHEMER D.O. L.L.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:
RANDY R. SHEMER D.O. L.L.C.
Provider Other Organization Name Type Code:
5
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:
1336273218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3419 BRODHEAD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONACA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15061-3131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-770-0771
Provider Business Mailing Address Fax Number:
724-770-0607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3419 BRODHEAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONACA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15061-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-770-0771
Provider Business Practice Location Address Fax Number:
724-770-0607
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEMER
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-770-0771

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS-008808L , 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: 0015442300007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com