1437128683 NPI number — HOWARD R HARTZELL III OD

Table of content: HOWARD R HARTZELL III OD (NPI 1437128683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437128683 NPI number — HOWARD R HARTZELL III OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTZELL
Provider First Name:
HOWARD
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1437128683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 LEADERS HEIGHTS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-747-5430
Provider Business Mailing Address Fax Number:
717-747-5230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 LEADERS HEIGHTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17402-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-747-5430
Provider Business Practice Location Address Fax Number:
717-747-5230
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG001116 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: TA0952 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001269000 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0082845000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50045687 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: POO218215 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012690000004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1308JC . This is a "CAREFIRST BCBS PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T274 0003 . This is a "CAREFIRST BCBS HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: HA136628 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: T274 0003 . This is a "CAREFIRST BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 50045687 . This is a "KEYSTONE HPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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