1487624011 NPI number — MOUNTAIN TOP FIRE COMPANY

Table of content: (NPI 1487624011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487624011 NPI number — MOUNTAIN TOP FIRE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN TOP FIRE COMPANY
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:
1487624011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50
Provider Second Line Business Mailing Address:
392 STATE STREET
Provider Business Mailing Address City Name:
SANDY RIDGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16677-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-342-5014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
392 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY RIDGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16677-0050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-5014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TORMEY
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
814-339-7410

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  14008 , 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: 53750 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000281689 . This is a "HIGHMARD" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 0007064790001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 281689 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 281689 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590008214 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: M0281689 . This is a "MAJOR MEDICAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P021512 . This is a "CHAMPUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30430 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 321407 . This is a "UPMC HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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