1093109092 NPI number — KRISTA R BUCHANAN

Table of content: KRISTA R BUCHANAN (NPI 1093109092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093109092 NPI number — KRISTA R BUCHANAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCHANAN
Provider First Name:
KRISTA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1093109092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 961
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EFFORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18330-0961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-656-4047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 CUB CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18330-8035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-656-4047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235500000X , with the licence number:  3975912 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 3975912 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 3975912 , 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: 0421880137-8 . This is a "PROFESIONAL INSURANCE POLICY NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0421880137-8 . This is a "INSURANCE POLICY IDENTIFYING NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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