1639189889 NPI number — TITUSVILLE AREA HEALTH SERVICES, INC.

Table of content: (NPI 1639189889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639189889 NPI number — TITUSVILLE AREA HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TITUSVILLE AREA HEALTH SERVICES, 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:
1639189889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 W OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TITUSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16354-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-827-1852
Provider Business Mailing Address Fax Number:
814-827-8419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 W OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TITUSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16354-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-827-1852
Provider Business Practice Location Address Fax Number:
814-827-8419
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEELY
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
814-827-1852

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007717100022 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007717100006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007717100008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007717100009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007717100010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007717100021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH2780 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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