1033172556 NPI number — DCA OF CHAMBERSBURG, INC.

Table of content: (NPI 1033172556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033172556 NPI number — DCA OF CHAMBERSBURG, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DCA OF CHAMBERSBURG, 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:
U S RENAL CARE CHAMBERSBURG DIALYSIS
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:
1033172556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72403-6601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-931-5400
Provider Business Mailing Address Fax Number:
870-931-5418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 5TH AVE
Provider Second Line Business Practice Location Address:
FIFTH AVE PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-263-9300
Provider Business Practice Location Address Fax Number:
717-263-7879
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT & SECRETARY
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01741721 . This is a "HEALTHMATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34493 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1265899 . This is a "GETTYSBURG HEALTH ADMIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 265899 . This is a "MAMSI ALLIANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1850 . This is a "PA HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2125722 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1527304 . This is a "GATEWAY MEDICARE ASSURED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PPA01555 . This is a "PA CHRONIC RENAL PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017417210001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01741721 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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