1386823755 NPI number — GREGG L. GOLDSTROHM, MD PC

Table of content: (NPI 1386823755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386823755 NPI number — GREGG L. GOLDSTROHM, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGG L. GOLDSTROHM, MD PC
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:
1386823755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 W NEWTON ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-2819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-832-6490
Provider Business Mailing Address Fax Number:
724-834-8336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 W NEWTON ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-6490
Provider Business Practice Location Address Fax Number:
724-834-8336
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSTROHM
Authorized Official First Name:
GREGG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-832-6490

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016711530001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006386 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104244 . This is a "UPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA0732 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250003 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000065367 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 661818 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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