1902837479 NPI number — REGIONAL ORTHOPEDIC HEALTH CENTER

Table of content: (NPI 1902837479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902837479 NPI number — REGIONAL ORTHOPEDIC HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL ORTHOPEDIC HEALTH CENTER
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:
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:
1902837479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 517
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZLETON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18201-0517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-450-6200
Provider Business Mailing Address Fax Number:
570-450-6207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501-07 SOUTH 12TH STREET
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147-1195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-0600
Provider Business Practice Location Address Fax Number:
215-925-6899
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YARUS
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
D.O./PRESIDENT
Authorized Official Telephone Number:
215-925-0600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  OS004974L , 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: 0011955790003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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