1386837268 NPI number — PENN OHIO REHABILITATION, PC

Table of content: (NPI 1386837268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386837268 NPI number — PENN OHIO REHABILITATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN OHIO REHABILITATION, 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:
1386837268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1599 N HERMITAGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16148-3180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-972-7920
Provider Business Mailing Address Fax Number:
724-962-6029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1599 N HERMITAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-972-7920
Provider Business Practice Location Address Fax Number:
724-962-6029
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLZWORTH
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT/OWNER
Authorized Official Telephone Number:
724-962-7920

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 579C . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 697483 . This is a "HEALTH ASSURANCE/HEALTH A" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 023575XCG . This is a "REBECCA SYERSAK-MURCKO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 095209XCG . This is a "KRISTEN NOLLINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 118111 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 724159 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 023572XCG . This is a "LARRY MATTOCKS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 517630XCG . This is a "RICHARD HOLZWORTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 042150XCG . This is a "DOUGLAS ORENDI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1983093 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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