1396052171 NPI number — JRMC PHYSICIAN SERVICES CORPORATION - DEAN ORNISH

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 1396052171 NPI number — JRMC PHYSICIAN SERVICES CORPORATION - DEAN ORNISH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JRMC PHYSICIAN SERVICES CORPORATION - DEAN ORNISH
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:
1396052171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18119
Provider Second Line Business Mailing Address:
MOB # 310
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15236-0119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-469-7932
Provider Business Mailing Address Fax Number:
412-469-5493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 FIFTH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15222-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-653-1391
Provider Business Practice Location Address Fax Number:
412-653-1394
Provider Enumeration Date:
09/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FRANK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE VP & COO, CORP ADMIN
Authorized Official Telephone Number:
412-469-5487

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 603459 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1154450179 . This is a "NPI #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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