1174720858 NPI number — DR. HEATHER L GRISAFI MD

Table of content: DR. HEATHER L GRISAFI MD (NPI 1174720858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174720858 NPI number — DR. HEATHER L GRISAFI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRISAFI
Provider First Name:
HEATHER
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1174720858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 ACEE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATRONA HEIGHTS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-223-5544
Provider Business Mailing Address Fax Number:
724-294-3206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE HOSPITAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-284-4622
Provider Business Practice Location Address Fax Number:
724-284-4470
Provider Enumeration Date:
06/27/2007

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: 2085R0202X , with the licence number:  MD438821 , 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: 1024595200002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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