1255817243 NPI number — MON VALE ORTHOPEDIC GROUP, INC.

Table of content: (NPI 1255817243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255817243 NPI number — MON VALE ORTHOPEDIC GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MON VALE ORTHOPEDIC GROUP, 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:
1255817243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 PLAZA DRIVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BELLE VERNON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-379-5816
Provider Business Mailing Address Fax Number:
724-379-5874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
371 SKYLINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIFORNIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15419-1278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-648-3862
Provider Business Practice Location Address Fax Number:
724-938-3039
Provider Enumeration Date:
07/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FERGUSON
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
724-379-5802

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0011318300010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150719 . This is a "HIGHMARK BC BS" identifier . This identifiers is of the category "OTHER".




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