1417139213 NPI number — PATRICK J MCANDREW, D.O. PC

Table of content: (NPI 1417139213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417139213 NPI number — PATRICK J MCANDREW, D.O. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK J MCANDREW, D.O. 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:
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:
1417139213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANDLING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18421-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-785-3194
Provider Business Mailing Address Fax Number:
570-785-9775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANDLING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18421-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-785-3194
Provider Business Practice Location Address Fax Number:
570-785-9775
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCANDREW
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-785-3194

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  OS002860L , 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: 51793 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002912 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00686447 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147451 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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