1356429310 NPI number — PENN FAMILY MEDICINE

Table of content: MR. ARTHUR STEVE MITCHELL LCDC (NPI 1134856016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356429310 NPI number — PENN FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN FAMILY MEDICINE
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:
1356429310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
639 WYNONAH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17922-9402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-898-9200
Provider Business Mailing Address Fax Number:
610-898-9188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4885 DEMOSS RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19606-9023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-898-9200
Provider Business Practice Location Address Fax Number:
610-898-9188
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHORSCHINSKY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-898-9200

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  05-009487-L , 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: 0731031000 . This is a "INDIV. ID DHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01168001 . This is a "INDIV. ID BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 280998 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02338600 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1708315 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4535653 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 977114 . This is a "INDIV. ID KHPC & SENIOR B" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000125507 . This is a "UNISON/THREE RIVERS PROV" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0721895001 . This is a "GROUP ID KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080170263 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 346961 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 59548 S1DF . This is a "GELSINGER IND PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SC977114 . This is a "HIGHMARK PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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