1497708887 NPI number — WILLIAM WALKER HOSE COMPANY

Table of content: (NPI 1497708887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497708887 NPI number — WILLIAM WALKER HOSE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM WALKER HOSE 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:
1497708887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERMYN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18433-0013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-876-1671
Provider Business Mailing Address Fax Number:
570-876-5167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 PENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18433-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-876-1671
Provider Business Practice Location Address Fax Number:
570-876-5167
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YANOCHIK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-876-1671

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04212 , 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: 998520 . This is a "BLUE CROSS NORTHEAST PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080046300 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 441590698 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 073804 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012293090001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74265 . This is a "UNISON MEDICAID HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30755 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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