1992754014 NPI number — HYNDMAN AREA HEALTH CENTER, INC.

Table of content: (NPI 1992754014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992754014 NPI number — HYNDMAN AREA HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HYNDMAN AREA HEALTH CENTER, 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:
BEDFORD FAMILY HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1992754014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 FIFTH AVENUE
Provider Second Line Business Mailing Address:
PO BOX 706
Provider Business Mailing Address City Name:
HYNDMAN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15545-0706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-842-3206
Provider Business Mailing Address Fax Number:
814-842-9169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 FIFTH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYNDMAN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15545-0706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-842-3206
Provider Business Practice Location Address Fax Number:
814-842-9169
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KURTYCZ
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
814-709-9801

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  USD032440 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007332810011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 402063700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120657 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3810008167 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007332810003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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