1407996978 NPI number — OLIVER W. CAMINOS

Table of content: (NPI 1407996978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407996978 NPI number — OLIVER W. CAMINOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLIVER W. CAMINOS
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:
1407996978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 JAMES PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-373-7900
Provider Business Mailing Address Fax Number:
412-372-1645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 JAMES PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-373-7900
Provider Business Practice Location Address Fax Number:
412-372-1645
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAMINOS
Authorized Official First Name:
OLIVER
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
412-372-2035

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD035918L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007237000001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0343917 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205751 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000065031 . This is a "UNISON ADMINISTRATIVE SERVICES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1008637 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1361782 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 219771 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 198494 . This is a "KEYSTONE HEALTH PLAN WEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9618472 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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