1003086455 NPI number — ST LUKES HOMESTAR SERVICES LLC

Table of content: DR. ALAN RICHARD SMITH O.D. (NPI 1942316054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003086455 NPI number — ST LUKES HOMESTAR SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES HOMESTAR SERVICES LLC
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:
6
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:
1003086455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 S COMMERCE WAY
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-8917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-954-4210
Provider Business Mailing Address Fax Number:
610-882-0246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 S COMMERCE WAY
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-8917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-954-4210
Provider Business Practice Location Address Fax Number:
610-882-0246
Provider Enumeration Date:
03/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BORGIONI
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY ADMINISTRATOR
Authorized Official Telephone Number:
484-526-7650

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  FH0725412 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 1000002573 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PP-481788 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: PP-481788 , 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: 1021941790003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 213649 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6112210002 . This is a "MEDICARE NHIC PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39HA15 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 121601 . This is a "THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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