1205830148 NPI number — CLEAR-CARE CORPORATION

Table of content: (NPI 1205830148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205830148 NPI number — CLEAR-CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAR-CARE CORPORATION
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:
1205830148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16830-5411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-765-0221
Provider Business Mailing Address Fax Number:
814-765-3590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-765-0221
Provider Business Practice Location Address Fax Number:
814-765-3590
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RIDGWAY
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-765-0221

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1476763 . This is a "UMWA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 040794100 . This is a "BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60552 . This is a "HEALTHAMERICA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 211456 . This is a "UPMC HEALTH PLAN PROVIDER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P034592 . This is a "TRICARE PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000058140007 , issued by the state of ( PW ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1567870 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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