1073739140 NPI number — DENNIS A DEBIAS M D P C

Table of content: (NPI 1073739140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073739140 NPI number — DENNIS A DEBIAS M D P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENNIS A DEBIAS M D P C
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:
DELPHI 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:
1073739140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 GRAVEL PIKE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SCHWENKSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19473-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-287-6650
Provider Business Mailing Address Fax Number:
610-287-6652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 GRAVEL PIKE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SCHWENKSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19473-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-287-6650
Provider Business Practice Location Address Fax Number:
610-287-6652
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEBIAS
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER AND PRESIDENT
Authorized Official Telephone Number:
610-287-6650

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD039666E , 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: 001427743 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015412750006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2114611000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2114611001 . This is a "KEYSTONE HEALTHPLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000139129 . This is a "AETNA USHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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