1013274323 NPI number — AMERACARE, LLC

Table of content: CONCHITA MARIA JACOBO OYOLA MD (NPI 1659959492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013274323 NPI number — AMERACARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERACARE, 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:
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:
1013274323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
SOUTHAMPTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18966-4029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-417-3434
Provider Business Mailing Address Fax Number:
215-396-2870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18966-4029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-417-3434
Provider Business Practice Location Address Fax Number:
215-396-2870
Provider Enumeration Date:
04/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ZABLUDOVSKY
Authorized Official First Name:
LEON
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
267-417-3434

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  09063 , 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: 09063 . This is a "PA DEPARTMENT OF HEALTH EMS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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