1285625665 NPI number — INTERNAL MEDICINE ASSOCIATES OF LAWRENCE COUNTY, P.C.

Table of content: (NPI 1285625665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285625665 NPI number — INTERNAL MEDICINE ASSOCIATES OF LAWRENCE COUNTY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE ASSOCIATES OF LAWRENCE COUNTY, P.C.
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:
1285625665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 ENCLAVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16105-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-658-6656
Provider Business Mailing Address Fax Number:
724-658-6542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 ENCLAVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-658-6656
Provider Business Practice Location Address Fax Number:
724-658-6542
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAGDA
Authorized Official First Name:
JERZY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-658-6656

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1514246 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: IN542479 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 621487 . This is a "TRIGON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 114792 . This is a "THREE RIVERS/MED PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 134141 . This is a "HEALTH AMERICA/ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A686 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DB6644 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 94508 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018423680005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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