1801926951 NPI number — MAXIS MEDICAL SERVICES

Table of content: (NPI 1801926951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801926951 NPI number — MAXIS MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXIS MEDICAL SERVICES
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:
MAXIS SURGICAL SERVICES
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:
1801926951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 SALEM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18407-2574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 SALEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-2574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-281-1287
Provider Business Practice Location Address Fax Number:
570-281-1256
Provider Enumeration Date:
03/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAUTRINOT
Authorized Official First Name:
MARY THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
570-281-1000

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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