1184611204 NPI number — KERRI MARIE MATEER P.A.-C.

Table of content: KERRI MARIE MATEER P.A.-C. (NPI 1184611204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184611204 NPI number — KERRI MARIE MATEER P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATEER
Provider First Name:
KERRI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
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:
1184611204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N ACADEMY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-6144
Provider Business Mailing Address Fax Number:
570-271-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 POPLAR CHURCH RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-724-6450
Provider Business Practice Location Address Fax Number:
717-724-6451
Provider Enumeration Date:
10/04/2005

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: 363AM0700X , with the licence number:  MA052135 , 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: 108766RQJ . This is a "MEDICARE PIN - PINNACLEHE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 092873EC5 . This is a "MEDICARE PIN - ASSOC CARD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00362151 . This is a "MEDICARE RAILROAD - ASSOC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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