1891930566 NPI number — MERAKEY PENNSYLVANIA

Table of content: (NPI 1891930566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891930566 NPI number — MERAKEY PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERAKEY PENNSYLVANIA
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:
NHS PENNSYLVANIA
Provider Other Organization Name Type Code:
4
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:
1891930566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4391 STURBRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-3673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-836-3131
Provider Business Mailing Address Fax Number:
215-273-5975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-836-3131
Provider Business Practice Location Address Fax Number:
215-273-5975
Provider Enumeration Date:
12/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TILSON
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CORP SR. DIRECTOR OF BUSINESS OPS
Authorized Official Telephone Number:
215-836-3131

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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