1538150578 NPI number — JONATHAN E ROSS O.D.

Table of content: JONATHAN E ROSS O.D. (NPI 1538150578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538150578 NPI number — JONATHAN E ROSS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
JONATHAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1538150578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 LEWIS RUN RD
Provider Second Line Business Mailing Address:
SUITE 218
Provider Business Mailing Address City Name:
WEST MIFFLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15122-3056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-466-9582
Provider Business Mailing Address Fax Number:
412-466-7906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 LEWIS RUN RD
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
WEST MIFFLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15122-3056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-466-9582
Provider Business Practice Location Address Fax Number:
412-466-7906
Provider Enumeration Date:
10/31/2005

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: 152W00000X , with the licence number:  OEG001711 , 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: 266195 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 251100359004 . This is a "CAHMPVA/ TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 266195 . This is a "HEALTH AMERICA/ HEALTH AS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "9872744" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1054419 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7128770 . This is a "AETNA COMMERCIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101541859 . This is a "MEDICAID PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410781 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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