1538157342 NPI number — ALLENTOWN ANESTHESIA ASSOCIATES, INC.

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 1538157342 NPI number — ALLENTOWN ANESTHESIA ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLENTOWN ANESTHESIA ASSOCIATES, INC.
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:
1538157342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4905 W. TILGHMAN ST
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-866-9583
Provider Business Mailing Address Fax Number:
610-366-1147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4905 W. TILGHMAN ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-866-9583
Provider Business Practice Location Address Fax Number:
610-366-1147
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOTY
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
484-866-9583

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , 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: P003209 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 46933 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7066511 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3527409 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AL6651 . This is a "KEYSTONE CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007166800008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0040553000 . This is a "INDEP. BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 066511 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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