1043268568 NPI number — FAMILY PLANNING SERVICES OF SUN/ WOMEN'S HEALTH SERVICES OF MJ

Table of content: (NPI 1043268568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043268568 NPI number — FAMILY PLANNING SERVICES OF SUN/ WOMEN'S HEALTH SERVICES OF MJ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PLANNING SERVICES OF SUN/ WOMEN'S HEALTH SERVICES OF MJ
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:
1043268568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4612 WESTBRANCH HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17837-6607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-523-3462
Provider Business Mailing Address Fax Number:
570-524-4197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4612 WESTBRANCH HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-6607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-523-3462
Provider Business Practice Location Address Fax Number:
570-524-4197
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOSER
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
570-523-3600

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  3423 , 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: FA925243 . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02683900 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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