1962534552 NPI number — ST. GEORGE & CO, INC.

Table of content: (NPI 1962534552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962534552 NPI number — ST. GEORGE & CO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. GEORGE & CO, INC.
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:
CAROL L. ST. GEORGE, D.O.
Provider Other Organization Name Type Code:
4
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:
1962534552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1776 S QUEEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-4628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-845-6261
Provider Business Mailing Address Fax Number:
717-852-0630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1776 S QUEEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-4628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-845-6261
Provider Business Practice Location Address Fax Number:
717-852-0630
Provider Enumeration Date:
03/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ST. GEORGE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
LINDA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-845-6261

Provider Taxonomy Codes

  • Taxonomy code: 207YX0602X , with the licence number:  OS004419L , 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: 1338861 . This is a "HIGHMARK BLUE SHIELD ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02548800 . This is a "CAPITAL BLUE CROSS ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0009788350002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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