1699764712 NPI number — PRIME ANESTHESIA CONSULTANTS INC.

Table of content: (NPI 1699764712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699764712 NPI number — PRIME ANESTHESIA CONSULTANTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME ANESTHESIA CONSULTANTS INC.
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:
GROVE CITY PAIN MANAGEMENT GROUP
Provider Other Organization Name Type Code:
3
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:
1699764712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1699 WASHINGTON RD
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15228-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-831-3744
Provider Business Mailing Address Fax Number:
412-831-5663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 S CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16127-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-264-4303
Provider Business Practice Location Address Fax Number:
724-264-4305
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TAIWO
Authorized Official First Name:
OLAKUNLE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-831-3744

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  MD067051L , 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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