1376508515 NPI number — THE FRIENDSHIP HOSE COMPANY NO 1 OF NEWVILLE PA

Table of content: (NPI 1376508515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376508515 NPI number — THE FRIENDSHIP HOSE COMPANY NO 1 OF NEWVILLE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FRIENDSHIP HOSE COMPANY NO 1 OF NEWVILLE PA
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:
NEWVILLE COMMUNITY AMBULACNE
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:
1376508515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 W MAIN ST
Provider Second Line Business Mailing Address:
PO BOX 3539
Provider Business Mailing Address City Name:
SHIREMANSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011-6326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-920-8460
Provider Business Mailing Address Fax Number:
717-901-5731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 EAST BIG SPRING ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-776-4747
Provider Business Practice Location Address Fax Number:
717-776-9321
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WISER
Authorized Official First Name:
TROY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-776-4747

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , 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: 011651300006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590010513 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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