1659525889 NPI number — MRS. MARCIA TAYLOR WERTZ CRNP

Table of content: BIANCA M FLUCAS (NPI 1548808611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659525889 NPI number — MRS. MARCIA TAYLOR WERTZ CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERTZ
Provider First Name:
MARCIA
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELFRICK
Provider Other First Name:
MARCIA
Provider Other Middle Name:
TAYLOR
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659525889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 E CENTRAL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15522-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-623-3474
Provider Business Mailing Address Fax Number:
814-623-3022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 E CENTRAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15522-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-623-3474
Provider Business Practice Location Address Fax Number:
814-623-3022
Provider Enumeration Date:
11/14/2008

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: 363L00000X , with the licence number:  SP010053 , 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: 1007307260037 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SP010053 . This is a "LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00768400 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 867633 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102368696 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-1716306 . This is a "INTERGROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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