1417288606 NPI number — UNIVERSITY CARDIOTHORACIC AND VASCULAR ASSOCIATES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417288606 NPI number — UNIVERSITY CARDIOTHORACIC AND VASCULAR ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY CARDIOTHORACIC AND VASCULAR ASSOCIATES, INC
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:
1417288606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 RADNOR RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
STATE COLLEGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16801-7986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-238-2616
Provider Business Mailing Address Fax Number:
814-238-0541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 RADNOR RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-7986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-238-2616
Provider Business Practice Location Address Fax Number:
814-238-0541
Provider Enumeration Date:
01/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-466-3434

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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