1326344128 NPI number — ENDURACARE ORTHOTIC AND PROSTHETIC SERVICES, LLC

Table of content: JEANNE BAKER RDN, LD (NPI 1255806725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326344128 NPI number — ENDURACARE ORTHOTIC AND PROSTHETIC SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDURACARE ORTHOTIC AND PROSTHETIC SERVICES, 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:
1326344128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
638 ROSTRAVER RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BELLE VERNON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012-1967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-930-8544
Provider Business Mailing Address Fax Number:
724-930-8545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 DANIEL DR
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-438-7900
Provider Business Practice Location Address Fax Number:
724-438-7903
Provider Enumeration Date:
01/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SERENARI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
724-350-0457

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  6000007742 , 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)





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