1831147933 NPI number — JOSE R ACOSTA M.D.

Table of content: JOSE R ACOSTA M.D. (NPI 1831147933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831147933 NPI number — JOSE R ACOSTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACOSTA
Provider First Name:
JOSE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1831147933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 HIGHLAND AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17044-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-242-7707
Provider Business Mailing Address Fax Number:
717-242-7083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 SANDY LANE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-2711
Provider Business Practice Location Address Fax Number:
717-248-0502
Provider Enumeration Date:
05/04/2006

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: 174400000X , with the licence number:  MD038970L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060000161 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02552500 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 076706 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008056460001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000805646 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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