1992185458 NPI number — COMMUNITY HEALTH NET

Table of content: MARIE-PIER WINTERS MSPT (NPI 1760833446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992185458 NPI number — COMMUNITY HEALTH NET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH NET
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:
GIRARD SCHOOL-BASED HEALTH CENTER
Provider Other Organization Name Type Code:
5
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:
1992185458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16512-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-454-4530
Provider Business Mailing Address Fax Number:
814-456-2375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 LAKE ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIRARD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16417-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-455-7222
Provider Business Practice Location Address Fax Number:
814-459-6678
Provider Enumeration Date:
05/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ULMER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
814-454-4530

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007543070054 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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