1710981592 NPI number — JOHN M. KASSI CCC-SLP-L

Table of content: JOHN M. KASSI CCC-SLP-L (NPI 1710981592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710981592 NPI number — JOHN M. KASSI CCC-SLP-L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASSI
Provider First Name:
JOHN
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP-L
Provider Gender Code:
M

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:
1710981592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
631 12TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16323-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-437-5600
Provider Business Mailing Address Fax Number:
814-432-7400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16323-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-437-5600
Provider Business Practice Location Address Fax Number:
814-432-7400
Provider Enumeration Date:
06/09/2005

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: 235Z00000X , with the licence number:  SL000964L , 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: 0018803870001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208593 . This is a "UPMC GROUP PROV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 385043 . This is a "HEALTH AMERICA INDIV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232982433001 . This is a "TRICARE GROUP PROV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018803960002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262033 . This is a "HIGHMARK INDIV. PROV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 340583 . This is a "HEALTH AMERICA GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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