1093955783 NPI number — CONEMAUGH HEALTH INITIATIVES

Table of content: (NPI 1093955783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093955783 NPI number — CONEMAUGH HEALTH INITIATIVES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONEMAUGH HEALTH INITIATIVES
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:
6
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:
1093955783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1086 FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15905-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-410-8300
Provider Business Mailing Address Fax Number:
814-410-8331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1704 PHILADELPHIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHERN CAMBRIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15714-1180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-948-0775
Provider Business Practice Location Address Fax Number:
814-948-0746
Provider Enumeration Date:
02/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LAMBERT
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-534-1630

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007358110157 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2079178 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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