1295003408 NPI number — FAYETTE SPECIALTY ASSOCIATES CARDIOLOGY

Table of content: (NPI 1295003408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295003408 NPI number — FAYETTE SPECIALTY ASSOCIATES CARDIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTE SPECIALTY ASSOCIATES CARDIOLOGY
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:
1295003408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 YOUNGSTOWN RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LEMONT FURNACE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15456-1344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-425-8334
Provider Business Mailing Address Fax Number:
724-434-1659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 MARY HIGGINSON LN
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-437-7073
Provider Business Practice Location Address Fax Number:
724-437-4636
Provider Enumeration Date:
12/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLER
Authorized Official Telephone Number:
724-425-8318

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com