1467403782 NPI number — GGNSC SHIPPENVILLE LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467403782 NPI number — GGNSC SHIPPENVILLE LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GGNSC SHIPPENVILLE LP
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:
1467403782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21158 PAINT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHIPPENVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16254-4024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-226-5660
Provider Business Mailing Address Fax Number:
814-226-9896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21158 PAINT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPPENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16254-4024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-226-5660
Provider Business Practice Location Address Fax Number:
814-226-9896
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RASMUSSEN-JONES
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
SEC. OF THE GP
Authorized Official Telephone Number:
479-201-4835

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  026002 , 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: 312367 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101558130 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1518751 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 126258 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000079446 . This is a "THREE RIVERS HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0654 . This is a "HIGHMARK WESTERN PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1015581300001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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