1013936392 NPI number — CAMBRIAN REHABILITATION ASSOCIATES, P.C.

Table of content: (NPI 1013936392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013936392 NPI number — CAMBRIAN REHABILITATION ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMBRIAN REHABILITATION ASSOCIATES, P.C.
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:
1013936392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
503 RAILROAD AVE
Provider Second Line Business Mailing Address:
SUITE 3 PATTON PLAZA
Provider Business Mailing Address City Name:
PATTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16668-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-674-2218
Provider Business Mailing Address Fax Number:
814-674-3716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 RAILROAD AVE
Provider Second Line Business Practice Location Address:
SUITE 3 PATTON PLAZA
Provider Business Practice Location Address City Name:
PATTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16668-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-674-2216
Provider Business Practice Location Address Fax Number:
814-674-3716
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURMEISTER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
814-672-5700

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT003879-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT006763-L , 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: 005842 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01896995 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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