1831163948 NPI number — FAYETTE MEDICAL ASSOCIATES INC

Table of content: (NPI 1831163948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831163948 NPI number — FAYETTE MEDICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTE MEDICAL ASSOCIATES 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:
THE DOCTORS OFFICE UNIONTOWN
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:
1831163948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 EASY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-434-1650
Provider Business Mailing Address Fax Number:
724-434-1659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 DELAWARE AVE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-434-1655
Provider Business Practice Location Address Fax Number:
724-430-3879
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PULICE
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLER
Authorized Official Telephone Number:
724-434-1650

Provider Taxonomy Codes

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

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

  • Identifier: 356573 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1028215 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 26055 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3411 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: WB20 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015441410017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62007 . This is a "UNIONTOWN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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