1437123007 NPI number — THE CRESCENT HOSE COMPANY

Table of content: (NPI 1437123007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437123007 NPI number — THE CRESCENT HOSE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CRESCENT HOSE COMPANY
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:
1437123007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 89
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH EAST
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16428-0089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-725-1047
Provider Business Mailing Address Fax Number:
814-725-2603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EAST
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16428-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-725-1047
Provider Business Practice Location Address Fax Number:
814-725-2603
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIORAZIO
Authorized Official First Name:
JACK
Authorized Official Middle Name:
Authorized Official Title or Position:
AMBULANCE ADMINISTRATOR
Authorized Official Telephone Number:
814-725-1047

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 286459 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 345104 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 103047504001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219622 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590015490 . This is a "PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590015490 . This is a "RR MEDICARE/PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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