1497709042 NPI number — SPECIALTY PHYSICIANS OF LVHN PC

Table of content: (NPI 1497709042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497709042 NPI number — SPECIALTY PHYSICIANS OF LVHN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY PHYSICIANS OF LVHN PC
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:
SPOLVHN PC CRSP
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:
1497709042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 VALLEY CENTER PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-884-4436
Provider Business Mailing Address Fax Number:
484-884-4444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2597 SCHOENERSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-7325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-884-1021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
X
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
484-884-1021

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , 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: 2454002000 . This is a "AMERIHEALTH (IBC)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01771558 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DB8269 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50056334 . This is a "KEYSTONE CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2454002000 . This is a "KEYSTONE EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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