1346614526 NPI number — PYRAMID HEALTHCARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346614526 NPI number — PYRAMID HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PYRAMID HEALTHCARE INC
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:
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:
1346614526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3180 ROUTE 611
Provider Second Line Business Mailing Address:
SUITE 19
Provider Business Mailing Address City Name:
BARTONSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18321-7824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-420-7939
Provider Business Mailing Address Fax Number:
610-434-1179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3180 ROUTE 611
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
BARTONSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18321-7824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-420-7939
Provider Business Practice Location Address Fax Number:
610-434-1179
Provider Enumeration Date:
11/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WOLF
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
814-940-0407

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007625050090 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 457042 . This is a "LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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