1588625628 NPI number — CENTRAL PA ORAL AND MAXILLOFACIAL SURGEONS

Table of content: (NPI 1588625628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588625628 NPI number — CENTRAL PA ORAL AND MAXILLOFACIAL SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PA ORAL AND MAXILLOFACIAL SURGEONS
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:
1588625628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 UNION DEPOSIT RD
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-3774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-540-1777
Provider Business Mailing Address Fax Number:
717-540-6857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 UNION DEPOSIT RD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-3774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-540-1777
Provider Business Practice Location Address Fax Number:
717-540-6857
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMAKER
Authorized Official First Name:
TAMMI
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL/INSURANCE MANAGER
Authorized Official Telephone Number:
717-909-3239

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DS020467L , 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: 484988 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02438800 . This is a "CB PROVIDER ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com