1467454504 NPI number — APPALACHIAN ORTHOPEDIC CENTER, LTD

Table of content: (NPI 1467454504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467454504 NPI number — APPALACHIAN ORTHOPEDIC CENTER, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN ORTHOPEDIC CENTER, LTD
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:
1467454504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DUNWOODY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17015-9565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-249-6112
Provider Business Mailing Address Fax Number:
717-249-6235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DUNWOODY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17015-9565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-249-6112
Provider Business Practice Location Address Fax Number:
717-249-6235
Provider Enumeration Date:
06/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HELY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-249-6112

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD027018E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: MD012191E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD419117 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD425826 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0009082310001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018918900001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0006107250002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012090400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".