1285855122 NPI number — ESTATE OF CECIL D FURER OD

Table of content: (NPI 1285855122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285855122 NPI number — ESTATE OF CECIL D FURER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESTATE OF CECIL D FURER OD
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:
1285855122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 FOURTH STREET
Provider Second Line Business Mailing Address:
PO BOX 367
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16229-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-295-5127
Provider Business Mailing Address Fax Number:
724-295-5130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 FOURTH STREET,
Provider Second Line Business Practice Location Address:
BOX 367
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16229-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-295-5127
Provider Business Practice Location Address Fax Number:
724-295-5130
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FURER
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
ADM OF ESTATE OF CECIL D FURER OD
Authorized Official Telephone Number:
724-295-5127

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000594 , 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: CF42000 . This is a "OPTUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 254325 . This is a "HAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 441540847 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4478201 . This is a "DAVIS CN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA4888 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006026700002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44782 . This is a "DAVIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080825 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141764 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390873 . This is a "NVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 314122 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA04888 . This is a "VBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397150 . This is a "NVA CN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 684163 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 684163 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: CF42000 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".




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