1497996748 NPI number — MR. JOSEPH T MARCIN, JR

Table of content: (NPI 1497996748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497996748 NPI number — MR. JOSEPH T MARCIN, JR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MR. JOSEPH T MARCIN, JR
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:
1497996748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62557-0230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-562-2432
Provider Business Mailing Address Fax Number:
217-562-2446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62557-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-562-2432
Provider Business Practice Location Address Fax Number:
217-562-2446
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARCIN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
217-562-2432

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046007210 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410006290 . This is a "RAILROAD MEDICARE/PALMETTO GBA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com