1013926757 NPI number — BELVEDERE MEDICAL CORPORATION

Table of content: (NPI 1013926757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013926757 NPI number — BELVEDERE MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELVEDERE MEDICAL CORPORATION
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:
BMC GYNECOLOGY
Provider Other Organization Name Type Code:
5
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:
1013926757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 WALNUT BOTTOM ROAD
Provider Second Line Business Mailing Address:
STE 302
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-3698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-258-5150
Provider Business Mailing Address Fax Number:
717-258-3392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 WALNUT BOTTOM ROAD
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-3698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-258-5150
Provider Business Practice Location Address Fax Number:
717-258-3392
Provider Enumeration Date:
08/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRANSCUM
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-243-1515

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 827814 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006561610001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02313200 . This is a "CAP BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".