1750410346 NPI number — VALLEY AMBULATORY HEALTH CENTER, P.C.

Table of content: (NPI 1750410346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750410346 NPI number — VALLEY AMBULATORY HEALTH CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY AMBULATORY HEALTH CENTER, P.C.
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:
1750410346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 486
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWARD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15954-0486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-446-5695
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 INDIANA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWARD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-446-5695
Provider Business Practice Location Address Fax Number:
814-446-4209
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ECKELS
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHYSICAN, OWNER OF COMPANY
Authorized Official Telephone Number:
814-446-5695

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS-003436-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OS-009298-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015077380001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01586199 . This is a "HIGHMARK BLUE CROSS BLUE SHIELD GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 073815 . This is a "ECKELS BLUE CROSS BLUE SH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00209792 . This is a "PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100236 . This is a "ECKELS UPMC ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 255520 . This is a "HEALTH AMERICA GROUP NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4556169 . This is a "ECKELS AETNA NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: OS-003436-L . This is a "ECKELS LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: B35010 . This is a "ECKELS UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1014729580001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613037300 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00223863 . This is a "PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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