1417124934 NPI number — MARCOE FAMILY EYECARE PC

Table of content: (NPI 1417124934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417124934 NPI number — MARCOE FAMILY EYECARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARCOE FAMILY EYECARE PC
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:
KATHY MARCOE, O.D. P.C.
Provider Other Organization Name Type Code:
4
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:
1417124934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16127-0094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-676-6979
Provider Business Mailing Address Fax Number:
814-676-6970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 KIMBERLY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANBERRY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16319-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-676-6979
Provider Business Practice Location Address Fax Number:
814-676-6970
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARCOE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-676-6979

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000069 , 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: 001922253 0005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102649777 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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