1245291483 NPI number — RIVERVIEW UROLOGIC ASSOCIATES

Table of content: (NPI 1245291483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245291483 NPI number — RIVERVIEW UROLOGIC ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW UROLOGIC ASSOCIATES
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:
1245291483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 3RD AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18704-5809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-288-3601
Provider Business Mailing Address Fax Number:
570-288-1726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-3601
Provider Business Practice Location Address Fax Number:
570-288-1726
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RITTENBERG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
HARRIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-288-3601

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31950 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000828 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02312200 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0006718740002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1039517 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 505911 . This is a "AETNA USHEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0900660001 . This is a "MEDICARE DME" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 034369 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0671874 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 811056 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CA9999 . This is a "TRAVELERS RAILROAD MEDICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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