1255400917 NPI number — GLEN E HOLLIDAY DC

Table of content: GLEN E HOLLIDAY DC (NPI 1255400917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255400917 NPI number — GLEN E HOLLIDAY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLIDAY
Provider First Name:
GLEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1255400917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CIRCLE DR
Provider Second Line Business Mailing Address:
A MANOWN PROFESSIONAL BUILDING
Provider Business Mailing Address City Name:
BELLE VERNON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012-9680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-929-8766
Provider Business Mailing Address Fax Number:
724-929-8767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CIRCLE DR
Provider Second Line Business Practice Location Address:
A MANOWN PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012-9680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-929-8766
Provider Business Practice Location Address Fax Number:
724-929-8767
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC003253L , 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: 329874 . This is a "HEALTH AMERICA HEALTH ASS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5457054 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01398348 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103337 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9082268 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 789620 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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