1649203969 NPI number — MARY ELLEN HICE CRNA

Table of content: BILLY J STROUD III (NPI 1588015309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649203969 NPI number — MARY ELLEN HICE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICE
Provider First Name:
MARY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1649203969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 FAIRFIELD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SENECA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16346-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-676-7843
Provider Business Mailing Address Fax Number:
814-676-7838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FAIRFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16346-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-676-7843
Provider Business Practice Location Address Fax Number:
814-676-7838
Provider Enumeration Date:
07/09/2006

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: 367500000X , with the licence number:  RN153354L , 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: 0019607640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 072952 . This is a "BLUE SHIELD BLK 33 PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 312161 . This is a "UPMC BLK 33 PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DD4802 . This is a "PALMETTO GBA BLK 33 GRP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 050555457 . This is a "COMMERCIAL BLK 33 GRP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 994588 . This is a "BLUE SHIELD BLK 33 PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00230587 . This is a "PALMETTO GBA BLK 33 PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019613040001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050555457 . This is a "UPMC BLK 33 GRP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1520056 . This is a "BLUE SHIELD BLK 33 GRP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 808862 . This is a "BLUE SHIELD BLK 33 GRP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: R88943 . This is a "COMMERCIAL BLK 33 PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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