1144212242 NPI number — MR. JOHN RICHARD MISHOCK MPT DC

Table of content: (NPI 1669550091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144212242 NPI number — MR. JOHN RICHARD MISHOCK MPT DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISHOCK
Provider First Name:
JOHN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPT DC
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:
1144212242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1806 SWAMP PIKE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GILBERTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19525-9307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-327-2600
Provider Business Mailing Address Fax Number:
610-327-9050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1806 SWAMP PIKE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GILBERTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19525-9307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-327-2600
Provider Business Practice Location Address Fax Number:
610-327-9050
Provider Enumeration Date:
08/16/2005

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: 111N00000X , with the licence number:  DC006576L , 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: PT012572L , 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: 1962428391 . This is a "GROUP NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 694511 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MI506229 . This is a "DC-HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0449992000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0264322000 . This is a "DC-KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0264322000 . This is a "DC-PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 38300034 . This is a "DC-AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0449992000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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