1316924335 NPI number — MARYELLEN RHOA CRNP

Table of content: DR. JACOB DOUGLAS COLLINS DO (NPI 1245850627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316924335 NPI number — MARYELLEN RHOA CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOA
Provider First Name:
MARYELLEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRUM RHOA
Provider Other First Name:
MARY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316924335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 PARK PLACE
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-5946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-229-7570
Provider Business Mailing Address Fax Number:
724-229-7571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 PARK PLACE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-5946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-229-7570
Provider Business Practice Location Address Fax Number:
724-229-7571
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  TP004243B , 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: 875375 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 500028008 . This is a "RAILROAD MEDICARE-VB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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