1124029681 NPI number — DR. DAVID RAY VILSACK DPM

Table of content: ASHLEY A LEDONNE FNP (NPI 1114453750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124029681 NPI number — DR. DAVID RAY VILSACK DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILSACK
Provider First Name:
DAVID
Provider Middle Name:
RAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1124029681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
532 S AIKEN AVE
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15232-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-621-5700
Provider Business Mailing Address Fax Number:
412-621-2890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 S AIKEN AVE
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15232-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-621-5700
Provider Business Practice Location Address Fax Number:
412-621-2890
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC001542L , 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: 0004292912 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1503489 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 887857 . This is a "BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 40683 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 65298 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 202304 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 480020822 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005031350012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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