1487610804 NPI number — PENNSYLVANIA AUTOMATED SERVICES, INC

Table of content: (NPI 1487610804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487610804 NPI number — PENNSYLVANIA AUTOMATED SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA AUTOMATED SERVICES, INC
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:
1487610804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRWIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15642-0340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-6830
Provider Business Mailing Address Fax Number:
724-527-6831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 CLAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-527-6830
Provider Business Practice Location Address Fax Number:
724-527-6831
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TORET
Authorized Official First Name:
MICHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
LAB DIRECTOR
Authorized Official Telephone Number:
724-527-6830

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  201940 , 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: 39D0694814 . This is a "CLIA NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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