1447247986 NPI number — EDGAR A BOONE JOY L BOONE MD

Table of content: (NPI 1447247986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447247986 NPI number — EDGAR A BOONE JOY L BOONE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDGAR A BOONE JOY L BOONE MD
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:
1447247986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMINIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15637-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-446-5571
Provider Business Mailing Address Fax Number:
724-446-2151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMINIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15637-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-446-5571
Provider Business Practice Location Address Fax Number:
724-446-2151
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOONE
Authorized Official First Name:
EDGAR
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-446-5571

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0473267 . This is a "AETNA GROUP ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 104152 . This is a "UPMC ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1409575 . This is a "UMWA ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DG3332 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003102 . This is a "GATEWAY ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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