1225095201 NPI number — MID ERIE MENTAL HEALTH SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225095201 NPI number — MID ERIE MENTAL HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID ERIE MENTAL HEALTH SERVICES INC
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:
1225095201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1526 WALDEN AVE
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-4965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-895-7167
Provider Business Mailing Address Fax Number:
716-382-4488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1526 WALDEN AVE
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14225-4965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-895-7167
Provider Business Practice Location Address Fax Number:
716-382-4488
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCINERNEY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
716-895-7167

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000506023001 . This is a "COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507788006 . This is a "BLUE CROSS MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000525284002 . This is a "BLUE CROSS MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528870001 . This is a "PPO BLUE CROSS MENTAL H" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0029795 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8401019 . This is a "IHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00011241001 . This is a "UNIVERA MEDICAL DOCTOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000525283001 . This is a "BLUE CROSS MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1131 . This is a "BLUE CROSS CHD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000524043001 . This is a "BLUE CROSS MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000859000 . This is a "PPO BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000500635005 . This is a "BLUE CROSS MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000858000 . This is a "PPO BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000081002150 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000809000 . This is a "PPO BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1526 . This is a "BLUE CROSS CHD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000504008007 . This is a "BLUE CROSS MENTAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 463 . This is a "BLUE CROSS CHD" identifier . This identifiers is of the category "OTHER".




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