1225095201 NPI number — MID ERIE MENTAL HEALTH SERVICES INC

Table of content: (NPI 1225095201)

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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" .

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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