1982714606 NPI number — RONALD KEVIN HICSWA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982714606 NPI number — RONALD KEVIN HICSWA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HICSWA

Provider First Name:

RONALD

Provider Middle Name:

KEVIN

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

M

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:

1982714606

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/22/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2775 SCHOENERSVILLE RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BETHLEHEM

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18017-7307

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-861-8080

Provider Business Mailing Address Fax Number:

610-807-0366

Provider First Line Business Practice Location Address:

2775 SCHOENERSVILLE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BETHLEHEM

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18017-7307

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-861-8080

Provider Business Practice Location Address Fax Number:

610-807-0366

Provider Enumeration Date:

08/30/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 50081231 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2070657 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 2038212 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 47241 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: PT018323 . This is a "STATE PT LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2274244000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 9261208 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 1566381 . This is a "GATEWAY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 6687993 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 40QA00900000 . This is a "LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2274244000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2274244000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
• Identifier: 50081231 . This is a "KEYSTONE HEALTH PLAN CENTRAL" identifier . This identifiers is of the category "OTHER".