1154592939 NPI number — SECURE HEALTH, LP

Table of content: (NPI 1154592939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154592939 NPI number — SECURE HEALTH, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SECURE HEALTH, LP
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:
1154592939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 W 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT CARMEL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17851-1855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-339-3909
Provider Business Mailing Address Fax Number:
570-339-1745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-3909
Provider Business Practice Location Address Fax Number:
570-339-1745
Provider Enumeration Date:
03/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KLINGERMAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
570-784-0111

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001450531 . This is a "BLUE SHIELD PROFESSIONAL" identifier . This identifiers is of the category "OTHER".




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