1447238563 NPI number — ELGIN BEAVERDAM HOSE CO

Table of content: (NPI 1447238563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447238563 NPI number — ELGIN BEAVERDAM HOSE CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELGIN BEAVERDAM HOSE CO
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:
1447238563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51
Provider Second Line Business Mailing Address:
17920 NORTH MIAN ST.
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16413-0051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-664-4140
Provider Business Mailing Address Fax Number:
814-664-4140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17920 NORTH MAIN ST.
Provider Second Line Business Practice Location Address:
BOX 51
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16413-0051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-664-4140
Provider Business Practice Location Address Fax Number:
814-664-4140
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AKAM
Authorized Official First Name:
SUSANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
814-664-4140

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04053 , 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: 288273 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010429360003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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