1972557254 NPI number — PAUL RICHARD PLUCKER M.S., CCC-A

Table of content: PAUL RICHARD PLUCKER M.S., CCC-A (NPI 1972557254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972557254 NPI number — PAUL RICHARD PLUCKER M.S., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUCKER
Provider First Name:
PAUL
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-A
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:
1972557254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 VALLEYVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATROBE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15650-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-537-3706
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 FRYE FARM RD
Provider Second Line Business Practice Location Address:
CENTRAL MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-539-3750
Provider Business Practice Location Address Fax Number:
724-539-3751
Provider Enumeration Date:
05/20/2006

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: 237600000X , with the licence number:  AT000051L , 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: 02615 . This is a "HEAR USA #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0420476 . This is a "GP# FOR UMWA FOR REPAIRS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 129034 . This is a "UMWA PROV.# FOR TESTING" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 209368 . This is a "UPMC GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 209368 . This is a "GROUP# FOR UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PL215605 . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: GPCE . This is a "RAILROAD MEDICARE GP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 27026 . This is a "GROUP#FOR HEALTH ASSUR.," identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 32262 . This is a "HEALTH AMERICA,ADVANTRA #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 490552 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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