1588998892 NPI number — SHARON EMERGENCY GROUP PC

Table of content: (NPI 1588998892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588998892 NPI number — SHARON EMERGENCY GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON EMERGENCY GROUP 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:
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:
1588998892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CORPORATE BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-3870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-893-9698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 E STATE ST
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:
16146-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-983-3911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-893-9698

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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