1780672956 NPI number — CHARLIE J PARSONS

Table of content: (NPI 1780672956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780672956 NPI number — CHARLIE J PARSONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLIE J PARSONS
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:
GREENCASTLE EYE CARE 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:
1780672956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 EASTERN AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
GREENCASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17225-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-597-7708
Provider Business Mailing Address Fax Number:
717-597-1052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 EASTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
GREENCASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17225-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-597-7708
Provider Business Practice Location Address Fax Number:
717-597-1052
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PARSONS
Authorized Official First Name:
ELISSA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
717-597-7708

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000051 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OEG001097 , 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: 1426790 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1535610 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02450500 . This is a "CAPITOL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 833045 . This is a "AETNA, HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5187071 . This is a "AETNA, PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5935579 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DF9974 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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