1548247455 NPI number — KEYSTONE QUALITY TRANSPORT COMPANY

Table of content: (NPI 1548247455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548247455 NPI number — KEYSTONE QUALITY TRANSPORT COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE QUALITY TRANSPORT COMPANY
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:
1548247455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2027
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-9027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-541-6610
Provider Business Mailing Address Fax Number:
610-541-6624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 E WOODLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-3969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-541-6610
Provider Business Practice Location Address Fax Number:
610-541-6624
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PLATT
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-566-2200

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  23209 , 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: 0000779015 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8100288 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480235 . This is a "AETNA USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000116000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0014336160003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009910 . This is a "KEYSTONE MERCY HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0143361601 . This is a "AMERICHOICE OF PA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13878 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 191041000 . This is a "MAGELLAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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