1235393620 NPI number — ANGEL BALCITA, MD, PC

Table of content: (NPI 1235393620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235393620 NPI number — ANGEL BALCITA, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL BALCITA, MD, PC
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:
1235393620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-547-0505
Provider Business Mailing Address Fax Number:
724-547-3942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1027 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-0505
Provider Business Practice Location Address Fax Number:
724-547-3942
Provider Enumeration Date:
07/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BALCITA
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
724-547-0505

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD030027E , 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: 055185 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00920307003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com