1649473729 NPI number — RONALD J OCONER D.O.

Table of content: RONALD J OCONER D.O. (NPI 1649473729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649473729 NPI number — RONALD J OCONER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCONER
Provider First Name:
RONALD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1649473729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 GRANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARVARD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60033-1821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-943-8094
Provider Business Mailing Address Fax Number:
815-943-8645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 GRANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVARD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60033-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-943-8094
Provider Business Practice Location Address Fax Number:
815-943-8645
Provider Enumeration Date:
06/07/2007

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: 207L00000X , with the licence number:  OS013538 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 036.122284 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 53011-21 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1019305800003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30567 . This is a "HEALTH PARTNERS - FB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01697 . This is a "HEALTH PARTNERS TC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019305800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30042806 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30042806 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1970005 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019305800002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2855609000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30563 . This is a "HEALTH PARTNERS - FF" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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