1366405847 NPI number — DIALYSIS SERVICES OF PENNSYLVANIA, INC- LEMOYNE

Table of content: (NPI 1366405847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366405847 NPI number — DIALYSIS SERVICES OF PENNSYLVANIA, INC- LEMOYNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS SERVICES OF PENNSYLVANIA, INC- LEMOYNE
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:
DCA OF LEMOYNE, INC.
Provider Other Organization Name Type Code:
3
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:
1366405847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 SENATE AVENUE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CAMP HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-730-9701
Provider Business Mailing Address Fax Number:
717-730-6223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 MILLER ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-730-6011
Provider Business Practice Location Address Fax Number:
717-730-9086
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVERETT
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-694-0500

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1851 . This is a "PA HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20007740 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1504321 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30021413 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015293320001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105531 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1529332 . This is a "HEALTHMATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1529332 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1529332 . This is a "AMERICHOICE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5277373 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34493 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PPA01548 . This is a "PA CHRONIC RENAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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