1164462669 NPI number — HUNTINGDON GASTROENTEROLOGY ASSOCIATES

Table of content: HALIE N KOCH (NPI 1831703404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164462669 NPI number — HUNTINGDON GASTROENTEROLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGDON GASTROENTEROLOGY ASSOCIATES
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:
1164462669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 BRYAN ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16652-2414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-643-1141
Provider Business Mailing Address Fax Number:
814-643-9451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 BRYAN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-1141
Provider Business Practice Location Address Fax Number:
814-643-9451
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WADDLE
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
814-643-1141

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 743142 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com