1265676647 NPI number — ALTOONA HAND AND WRIST SURGERY, LLC

Table of content: (NPI 1265676647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265676647 NPI number — ALTOONA HAND AND WRIST SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTOONA HAND AND WRIST SURGERY, LLC
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:
1265676647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 BRUSHMEADE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLIDAYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16648-2720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-935-0615
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE C2
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-942-7324
Provider Business Practice Location Address Fax Number:
814-942-7327
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GURMAN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-935-0615

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD035783E , 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: 29958 . This is a "GEISINGER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203307 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 842729 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1560035 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200005775 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GU135319 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1015435 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: GU135319 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010425150003 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5751466 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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