1467654517 NPI number — AUTUMN LORRAINE BEYER PA-C, ATC

Table of content: AUTUMN LORRAINE BEYER PA-C, ATC (NPI 1467654517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467654517 NPI number — AUTUMN LORRAINE BEYER PA-C, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEYER
Provider First Name:
AUTUMN
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMADY
Provider Other First Name:
AUTUMN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467654517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1086 FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15905-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-410-8300
Provider Business Mailing Address Fax Number:
814-410-8331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 MAIN ST
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15901-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-534-1095
Provider Business Practice Location Address Fax Number:
814-534-6145
Provider Enumeration Date:
06/01/2007

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: 2255A2300X , with the licence number:  RT004068 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , 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)





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