1487961744 NPI number — US REGIONAL OCCUPATIONAL HEALTH II PC

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 1487961744 NPI number — US REGIONAL OCCUPATIONAL HEALTH II PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US REGIONAL OCCUPATIONAL HEALTH II 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:
WORKNET OCCUPATIONAL MEDICINE
Provider Other Organization Name Type Code:
3
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:
1487961744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 GRAYSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-920-5910
Provider Business Mailing Address Fax Number:
717-920-5916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 GRAYSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-920-5910
Provider Business Practice Location Address Fax Number:
717-920-5916
Provider Enumeration Date:
09/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHILEY
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
PHYSICIAN ASSISTANT
Authorized Official Telephone Number:
717-920-5910

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  MA054429 , 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)





Copyright © 2007-2024 www.npivalidator.com