1255316378 NPI number — EMBROOKE INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255316378 NPI number — EMBROOKE INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBROOKE INCORPORATED
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:
6
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:
1255316378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
366 HELEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC KEES ROCKS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15136-2744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-331-2600
Provider Business Mailing Address Fax Number:
412-331-3133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
366 HELEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KEES ROCKS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15136-2744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-331-2600
Provider Business Practice Location Address Fax Number:
412-331-3133
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GORAS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
412-331-2600

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  02254 , 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: 306987 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007439020006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 248703 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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