1649515552 NPI number — NULTON DIAGNOSTIC & TREATMENT CENTER, PC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649515552 NPI number — NULTON DIAGNOSTIC & TREATMENT CENTER, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NULTON DIAGNOSTIC & TREATMENT CENTER, PC.
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:
1649515552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 COLLEGE PARK PLAZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-262-0025
Provider Business Mailing Address Fax Number:
814-266-8745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 FRANKLIN STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-410-2106
Provider Business Practice Location Address Fax Number:
814-410-2108
Provider Enumeration Date:
12/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GRIESHEIMER
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
814-262-0025

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  330020 , 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)





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