1770102402 NPI number — CENTRAL CARE, PA

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 1770102402 NPI number — CENTRAL CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL CARE, PA
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:
CENTRAL CARE CANCER CENTER
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:
1770102402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2337 E CRAWFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-823-0633
Provider Business Mailing Address Fax Number:
844-854-4662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-1117
Provider Business Practice Location Address Fax Number:
620-342-1185
Provider Enumeration Date:
04/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
CANDICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
620-603-8846

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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