1659390698 NPI number — COLON & RECTAL SURGERY, LTD.

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 1659390698 NPI number — COLON & RECTAL SURGERY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON & RECTAL SURGERY, LTD.
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:
1659390698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1088 W BALTIMORE PIKE
Provider Second Line Business Mailing Address:
SUITE 2101
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-5136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-565-3435
Provider Business Mailing Address Fax Number:
610-566-1387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
SUITE 2101
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-565-3435
Provider Business Practice Location Address Fax Number:
610-566-1387
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOYD
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-565-3435

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0009855080003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32129 . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0091202000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CF6297 . This is a "PALMETTO GBA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 190824 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com