1487177051 NPI number — JAMES BENJAMIN RAINEY LSW

Table of content: JAMES BENJAMIN RAINEY LSW (NPI 1487177051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487177051 NPI number — JAMES BENJAMIN RAINEY LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAINEY
Provider First Name:
JAMES
Provider Middle Name:
BENJAMIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAINEY
Provider Other First Name:
BEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487177051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 WEST ST APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKINSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15221-3339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 PENN AVE STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURTLE CREEK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15145-2082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-824-8510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2017

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: 1041C0700X , with the licence number:  SW134348 , 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)