1376829697 NPI number — PROVIDENCE HOME MEDICAL, L.P.

Table of content: (NPI 1376829697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376829697 NPI number — PROVIDENCE HOME MEDICAL, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDENCE HOME MEDICAL, L.P.
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:
1376829697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 VALLEY BROOK RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
MC MURRAY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-3375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-854-7436
Provider Business Mailing Address Fax Number:
866-876-9841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 VALLEY BOOK ROAD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
MC MURRAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-3375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-854-7436
Provider Business Practice Location Address Fax Number:
866-876-9841
Provider Enumeration Date:
11/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PETTIGREW
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
STEWART
Authorized Official Title or Position:
PRINCIPAL/OWNER
Authorized Official Telephone Number:
412-770-5689

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 108078900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com