1235258724 NPI number — COLON & RECTAL CARE CENTER OF PENNSYLVANIA LLC

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 1235258724 NPI number — COLON & RECTAL CARE CENTER OF PENNSYLVANIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON & RECTAL CARE CENTER OF PENNSYLVANIA LLC
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:
1235258724
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:
1225 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 302A
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-5370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-853-6580
Provider Business Mailing Address Fax Number:
724-853-6582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 302A
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-5370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-853-6580
Provider Business Practice Location Address Fax Number:
724-853-6582
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAPP
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER DOCTOR
Authorized Official Telephone Number:
724-853-6580

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1857264 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4240513 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1291853 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000919764002 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1796670 . This is a "HIGHMARK BLUES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 441474 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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