1013997204 NPI number — BLAIR COUNTY PLASTIC SURGERY INC.

Table of content: (NPI 1013997204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013997204 NPI number — BLAIR COUNTY PLASTIC SURGERY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLAIR COUNTY PLASTIC SURGERY 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:
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:
1013997204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 HAWTHORNE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HOLLIDAYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-949-7280
Provider Business Mailing Address Fax Number:
814-949-7283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HAWTHORNE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOLLIDAYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-949-7280
Provider Business Practice Location Address Fax Number:
814-949-7283
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUTON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-949-7280

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  MD045155E , 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: 240002639 . This is a "MEDICARE PALMETTO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00011873520001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: E83543 . This is a "PREFERRED HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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