1689972580 NPI number — TYLER MACCRONE EMT-BASIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689972580 NPI number — TYLER MACCRONE EMT-BASIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACCRONE
Provider First Name:
TYLER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EMT-BASIC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACCRONE
Provider Other First Name:
TYLER
Provider Other Middle Name:
DAVID
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA EMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689972580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 SEMINOLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-764-4009
Provider Business Mailing Address Fax Number:
610-876-7068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 SEMINOLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19074-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-764-4009
Provider Business Practice Location Address Fax Number:
610-876-7068
Provider Enumeration Date:
03/02/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X , with the licence number:  109291 , 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: 109291 . This is a "PA EMT #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".