1346367117 NPI number — KENT M. OZMAN

Table of content: (NPI 1346367117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346367117 NPI number — KENT M. OZMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENT M. OZMAN
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:
1346367117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 GEORGETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAZARETH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18064-9781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-746-6543
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 NAZARETH PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-9497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-746-6543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OZMAN
Authorized Official First Name:
KENT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-746-6543

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC005661L , 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: 02913400 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 814582 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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