1134266141 NPI number — SAINT CLAIR VETERANS MEMORIAL AMBULANCE FUND

Table of content: DR. ANDREA CRISTINA HUERTA OD (NPI 1023724002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134266141 NPI number — SAINT CLAIR VETERANS MEMORIAL AMBULANCE FUND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT CLAIR VETERANS MEMORIAL AMBULANCE FUND
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:
1134266141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLAIR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17970-0124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-429-1388
Provider Business Mailing Address Fax Number:
570-429-0655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 N 2ND ST # 47
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17970-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-429-1388
Provider Business Practice Location Address Fax Number:
570-429-0655
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOBELLA
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE CHIEF
Authorized Official Telephone Number:
570-429-1388

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04046 , 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: 0012172640004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50003036 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 441590643 . This is a "PALMETTO GBA RAILROAD MED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 283398 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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