1386635076 NPI number — A J TOLBERT & ASSOCIATES INC

Table of content: (NPI 1386635076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386635076 NPI number — A J TOLBERT & ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A J TOLBERT & ASSOCIATES 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:
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:
1386635076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SHADOW WOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNINGTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19335-4049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-269-6100
Provider Business Mailing Address Fax Number:
610-873-6687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SHADOW WOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNINGTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19335-4049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-269-6100
Provider Business Practice Location Address Fax Number:
610-873-6687
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TOLBERT
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-269-6100

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AT00281L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SL000071L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: D00378 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101427710 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30005306 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4360649 . This is a "AETNA AUD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001511227 . This is a "INDEP BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0027032000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0342973000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101422710 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101427710 0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001511228 . This is a "IBC PPO INDEP BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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