1699828509 NPI number — WALNUT MANAGEMENT CORPORATION

Table of content: (NPI 1699828509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699828509 NPI number — WALNUT MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALNUT MANAGEMENT CORPORATION
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:
WALNUT MEDICAL SERVICES
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:
1699828509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 MAIN ST
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:
15901-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-533-0901
Provider Business Mailing Address Fax Number:
815-533-0196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 S LOGAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17009-1869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-248-9938
Provider Business Practice Location Address Fax Number:
717-248-9939
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAISER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR, WMS
Authorized Official Telephone Number:
814-533-0901

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  3000007974 , 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: 0009718520005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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