1356524714 NPI number — HEALTHATLANTIC LLC

Table of content: (NPI 1356524714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356524714 NPI number — HEALTHATLANTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHATLANTIC 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:
1356524714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELVERSON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19520-0074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-789-0912
Provider Business Mailing Address Fax Number:
610-927-6339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BULLTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELVERSON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-789-0912
Provider Business Practice Location Address Fax Number:
610-927-6339
Provider Enumeration Date:
12/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARLET
Authorized Official First Name:
TROY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC MANAGER
Authorized Official Telephone Number:
800-789-0912

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  07001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 07001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1569126 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20080255 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1020857160002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30049520 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3504884000 . This is a "KEYSTONE 65" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002022122 . This is a "HIGHMARK BXBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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