1760446801 NPI number — KELLY S. REMINGTON RPA-C

Table of content: KELLY S. REMINGTON RPA-C (NPI 1760446801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760446801 NPI number — KELLY S. REMINGTON RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REMINGTON
Provider First Name:
KELLY
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
F

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:
1760446801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4511 HARLEM ROAD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-839-6720
Provider Business Mailing Address Fax Number:
716-839-6740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 BRYANT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14222-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-878-7300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2006

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: 363A00000X , with the licence number:  0070481 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 007048 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000570244007 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00026494802 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000Z6494801 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02344801 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060921000000 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000570244003 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9511857 . This is a "IHA" identifier . This identifiers is of the category "OTHER".




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