1215026935 NPI number — CHICORA INDEPENDENT HOSE COMPANY

Table of content: MARY ELLEN LYONS PA (NPI 1902050420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215026935 NPI number — CHICORA INDEPENDENT HOSE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICORA INDEPENDENT HOSE COMPANY
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:
1215026935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 WEST SLIPPERY ROCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICORA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16025-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-445-2220
Provider Business Mailing Address Fax Number:
724-445-2167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 WEST SLIPPERY ROCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICORA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16025-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-445-2220
Provider Business Practice Location Address Fax Number:
724-445-2167
Provider Enumeration Date:
10/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
724-445-2220

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  06004 , 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: 0010621510001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".