1093870255 NPI number — SKIPPACK CLINICAL LAB

Table of content: (NPI 1093870255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093870255 NPI number — SKIPPACK CLINICAL LAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKIPPACK CLINICAL LAB
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:
SKIPPACK MEDICAL LABORATORY
Provider Other Organization Name Type Code:
5
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:
1093870255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 817
Provider Second Line Business Mailing Address:
3887 SKIPPACK PIKE
Provider Business Mailing Address City Name:
SKIPPACK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19474-0817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-584-1669
Provider Business Mailing Address Fax Number:
610-584-5188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3887 SKIPPACK PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKIPPACK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19474-0817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-584-1669
Provider Business Practice Location Address Fax Number:
610-584-5188
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMIN
Authorized Official First Name:
HASU
Authorized Official Middle Name:
B
Authorized Official Title or Position:
LAB SUPERVISOR
Authorized Official Telephone Number:
610-584-1669

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  000421 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: SK301440 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 000983405 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000983405 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000421 . This is a "MEDICARE BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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