1558322420 NPI number — THOMAS R STEBBINS PAC

Table of content: THOMAS R STEBBINS PAC (NPI 1558322420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558322420 NPI number — THOMAS R STEBBINS PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEBBINS
Provider First Name:
THOMAS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1558322420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1281
Provider Second Line Business Mailing Address:
CO GOOD SAMARITAN HOSPITAL
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17042-1281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-270-7740
Provider Business Mailing Address Fax Number:
717-270-3877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4TH & WALNUT STREETS
Provider Second Line Business Practice Location Address:
GOOD SAMARITAN HOSPITAL
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-270-7740
Provider Business Practice Location Address Fax Number:
717-270-3877
Provider Enumeration Date:
03/30/2006

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: 363A00000X , with the licence number:  MA001330L , 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: 03246501 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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