1497969802 NPI number — ANESTHESIA & PAIN MANAGEMENT ASSOCIATES INC

Table of content: (NPI 1497969802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497969802 NPI number — ANESTHESIA & PAIN MANAGEMENT ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA & PAIN MANAGEMENT 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:
1497969802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12878
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19101-0878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-232-8611
Provider Business Mailing Address Fax Number:
770-232-8618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 CREE DR
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-893-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TALREJA
Authorized Official First Name:
RAMESH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
570-893-5000

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207LP2900X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1010493590001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AN1646743 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".