1528024700 NPI number — WYOMISSING ORAL SURGICAL ASSOCS, LTD

Table of content: CLAIRE STEVENSON (NPI 1710437165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528024700 NPI number — WYOMISSING ORAL SURGICAL ASSOCS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMISSING ORAL SURGICAL ASSOCS, 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:
1528024700
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:
6 HEARTHSTONE CT
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19606-3065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-370-2300
Provider Business Mailing Address Fax Number:
610-370-2303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 HEARTHSTONE CT
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19606-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-370-2300
Provider Business Practice Location Address Fax Number:
610-370-2303
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLASS
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-370-2300

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DS022591L , 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: 0011843970002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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