1154648970 NPI number — PERSONAL CHOICE QUALITY CARE REGISTRY

Table of content: DR. MONIQUE MOSTERT LOTNER M.D. (NPI 1649539289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154648970 NPI number — PERSONAL CHOICE QUALITY CARE REGISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL CHOICE QUALITY CARE REGISTRY
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:
1154648970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4395 OLD WILLIAM PENN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15668-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-390-8291
Provider Business Mailing Address Fax Number:
412-731-1482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4395 OLD WILLIAM PENN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15668-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-390-8291
Provider Business Practice Location Address Fax Number:
412-731-1482
Provider Enumeration Date:
05/04/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BUSINESS HEALTH ADMINISTAROR
Authorized Official Telephone Number:
888-390-8291

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  10093601 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 10093601 , 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)