1467698225 NPI number — KRISTEN S ROMESBURG DO

Table of content: KRISTEN S ROMESBURG DO (NPI 1467698225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467698225 NPI number — KRISTEN S ROMESBURG DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMESBURG
Provider First Name:
KRISTEN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCALISE
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467698225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1263 STATE ROUTE 40 W
Provider Second Line Business Mailing Address:
PO BOX N
Provider Business Mailing Address City Name:
CLAYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15323-1277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-663-7731
Provider Business Mailing Address Fax Number:
724-663-9022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1263 STATE ROUTE 40 W
Provider Second Line Business Practice Location Address:
PO BOX N
Provider Business Practice Location Address City Name:
CLAYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15323-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-663-7731
Provider Business Practice Location Address Fax Number:
724-663-9022
Provider Enumeration Date:
12/29/2008

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: 207Q00000X , with the licence number:  OS014822 , 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: 074430 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001526106 . This is a "HIGHMARK GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1024870700002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1184675035 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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