1548297781 NPI number — DBRRX, INC.

Table of content: (NPI 1548297781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548297781 NPI number — DBRRX, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DBRRX, 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:
PENN OHIO MEDICINE MART
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:
1548297781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 S IRVINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16146-1163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-347-5505
Provider Business Mailing Address Fax Number:
724-347-4995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 S IRVINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16146-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-347-5505
Provider Business Practice Location Address Fax Number:
724-347-4995
Provider Enumeration Date:
06/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RONCI
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-347-5505

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 415268 , 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: 1011073900001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2480015 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".