1700897147 NPI number — GENERAL SERVICE AND SUPPLY INC

Table of content: MISS CARYL RENEE CARRADINE RDH (NPI 1134516883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700897147 NPI number — GENERAL SERVICE AND SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERAL SERVICE AND SUPPLY 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:
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:
1700897147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2323 GREENTREE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARNEGIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15106-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-279-4114
Provider Business Mailing Address Fax Number:
412-279-6139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2323 GREENTREE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARNEGIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15106-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-279-4114
Provider Business Practice Location Address Fax Number:
412-279-6139
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT DENTIST
Authorized Official Telephone Number:
412-279-4114

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS025434L , 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: 489141 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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