1831489327 NPI number — MON-VALE ONCOLOGY, INC.

Table of content: (NPI 1831489327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831489327 NPI number — MON-VALE ONCOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MON-VALE ONCOLOGY, 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:
1831489327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HOSPITAL AVE
Provider Second Line Business Mailing Address:
ATTN PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
DUBOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-986-0698
Provider Business Mailing Address Fax Number:
814-372-2676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1163 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONONGAHELA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15063-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-292-9404
Provider Business Practice Location Address Fax Number:
724-292-9155
Provider Enumeration Date:
04/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
STRISHOCK
Authorized Official First Name:
JOURDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DELEGATED OFFICIAL/AUTHORIZED OFFIC
Authorized Official Telephone Number:
814-375-6160

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1525897 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 130506 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019980110001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 085188 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2937436 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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