1104119437 NPI number — FAMILY HEALTHCARE PARTNERS

Table of content: (NPI 1104119437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104119437 NPI number — FAMILY HEALTHCARE PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTHCARE PARTNERS
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:
1104119437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W BUTLER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16137-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-662-1930
Provider Business Mailing Address Fax Number:
724-662-5054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 SPRUCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIPPERY ROCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16057-1412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-794-3358
Provider Business Practice Location Address Fax Number:
724-794-1606
Provider Enumeration Date:
05/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KEIL
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
724-662-3943

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1530870 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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