1306262456 NPI number — LAND MEDICAL CORPORATION

Table of content: (NPI 1306262456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306262456 NPI number — LAND MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAND MEDICAL CORPORATION
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:
1306262456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 NESHAMINY INTERPLEX DR STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEASTERVILLE TREVOSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-6940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-294-6790
Provider Business Mailing Address Fax Number:
215-474-4418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 NESHAMINY INTERPLEX DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEASTERVILLE TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-6940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-294-6790
Provider Business Practice Location Address Fax Number:
215-474-4418
Provider Enumeration Date:
03/13/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BALOGUN
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
I
Authorized Official Title or Position:
CHAIRMAN/CEO
Authorized Official Telephone Number:
215-294-6790

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0018467050006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".