1346203171 NPI number — PRIME HEALTHCARE SERVICES LOWER BUCKS LLC

Table of content: (NPI 1346203171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346203171 NPI number — PRIME HEALTHCARE SERVICES LOWER BUCKS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME HEALTHCARE SERVICES LOWER BUCKS LLC
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:
1346203171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 BATH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19007-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-785-9200
Provider Business Mailing Address Fax Number:
215-785-9039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 BATH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19007-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-785-9200
Provider Business Practice Location Address Fax Number:
215-785-9039
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAVITALA
Authorized Official First Name:
RADHA
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY GENERAL COUNSEL
Authorized Official Telephone Number:
909-235-4309

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100745380 002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000348728 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30012055 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0776018000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com