1447476197 NPI number — MRS. CATHERINE A. ROSCOE

Table of content: MRS. CATHERINE A. ROSCOE (NPI 1447476197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447476197 NPI number — MRS. CATHERINE A. ROSCOE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSCOE
Provider First Name:
CATHERINE
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1447476197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 E PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMYRA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17078-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-838-1231
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 E PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMYRA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17078-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-838-1231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL002857L , 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: 1000029480004 . This is a "PROMISE PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".