1083673602 NPI number — PAUL L. KIEFFER

Table of content: (NPI 1083673602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083673602 NPI number — PAUL L. KIEFFER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL L. KIEFFER
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:
1083673602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1372 N SUSQUEHANNA TRL
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
SELINSGROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17870-8971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-743-4000
Provider Business Mailing Address Fax Number:
570-743-3105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1372 N SUSQUEHANNA TRL
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-8971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-4000
Provider Business Practice Location Address Fax Number:
570-743-3105
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIEFFER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
LESLIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-743-4000

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT003918L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT016781 , 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: 02406400 . This is a "PA BLUE CROSS GROUP NUMBE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 45928 . This is a "HEALTH AMERICA GROUP NUMB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 686027 . This is a "PA BLUE SHIELD GROUP NUMB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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