1013967645 NPI number — LIMA GERONTOLOGY ASSOCIATES LLP

Table of content: (NPI 1013967645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013967645 NPI number — LIMA GERONTOLOGY ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIMA GERONTOLOGY ASSOCIATES LLP
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:
1013967645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1098 W BALTIMORE PIKE
Provider Second Line Business Mailing Address:
STE 3311
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-565-7810
Provider Business Mailing Address Fax Number:
610-565-0546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 N MIDDLETOWN RD
Provider Second Line Business Practice Location Address:
FAIR ACRES GERIATRIC CENTER
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-565-7810
Provider Business Practice Location Address Fax Number:
610-565-0546
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARRIOS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
LESLIE
Authorized Official Title or Position:
MANAGING PARTNER LIMA GERONTOLOGY A
Authorized Official Telephone Number:
610-622-7159

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013299060001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: L11678226 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DC5598 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: DC5756 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".