1114045754 NPI number — MRS. KATHERINE KELLY PAPPAS OTRL

Table of content: IDA S KEMUNTO MAGATI (NPI 1558887356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114045754 NPI number — MRS. KATHERINE KELLY PAPPAS OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAPPAS
Provider First Name:
KATHERINE
Provider Middle Name:
KELLY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
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:
1114045754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-538-8680
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3023 WILMINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-656-8814
Provider Business Practice Location Address Fax Number:
724-656-8815
Provider Enumeration Date:
03/26/2007

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: 225X00000X , with the licence number:  OC006815L , 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: 0019702230002 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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