1013998079 NPI number — FARRELL AQUISITION CORPORATION

Table of content: (NPI 1013998079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013998079 NPI number — FARRELL AQUISITION CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARRELL AQUISITION CORPORATION
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:
6
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:
1013998079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4386 STURBRIDGE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-3668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-652-4924
Provider Business Mailing Address Fax Number:
717-652-1015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4386 STURBRIDGE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-3886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-652-4924
Provider Business Practice Location Address Fax Number:
717-652-1015
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
ELENA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-652-4924

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0614458 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: OP1605 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50025282 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 68052259A . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39808 . This is a "GEISINGER GOLD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1429299 . This is a "BLUE SHIELD VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 393570 . This is a "NVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39808 . This is a "GEISINGER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0614458 . This is a "SENIOR BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1429299 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5766476 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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