1700820909 NPI number — ELISEO M. ROQUIZ MD

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 1700820909 NPI number — ELISEO M. ROQUIZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELISEO M. ROQUIZ MD
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:
MILLCREEK ANESTHESIA 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:
1700820909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16512-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-454-8885
Provider Business Mailing Address Fax Number:
814-456-3856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5515 PEACH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16509-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-454-8885
Provider Business Practice Location Address Fax Number:
814-456-3856
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROQUIZ
Authorized Official First Name:
ELISEO
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
ANESTHESIOLOGIST
Authorized Official Telephone Number:
814-454-8885

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD022695E , 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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