1518976414 NPI number — BEDFORD REGIONAL UROLOGY, P.C.

Table of content: (NPI 1518976414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518976414 NPI number — BEDFORD REGIONAL UROLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEDFORD REGIONAL UROLOGY, P.C.
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:
STEPHEN J. YANOSHAK, D.O.
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:
1518976414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15522-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-623-0552
Provider Business Mailing Address Fax Number:
814-623-0752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15537-7057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-623-0552
Provider Business Practice Location Address Fax Number:
814-623-0752
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YANOSHAK
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
814-623-0552

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  OS007645L , 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: 3109330 . This is a "ALLIANCE PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 58742 . This is a "BLUE SHIELD PROVIDER NUMB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015887270009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17577760 . This is a "UPMC BEST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 204190 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3109330 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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