1336263730 NPI number — MRS. CATHY L BULLION MPT

Table of content: MRS. CATHY L BULLION MPT (NPI 1336263730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336263730 NPI number — MRS. CATHY L BULLION MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLION
Provider First Name:
CATHY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

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:
1336263730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 RENAISSANCE DR STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16001-7612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-256-9606
Provider Business Mailing Address Fax Number:
724-256-9609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15009-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
878-207-2192
Provider Business Practice Location Address Fax Number:
878-207-2193
Provider Enumeration Date:
03/19/2007

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: 225100000X , with the licence number:  PT003954L , 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: 1033094200001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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