1497741466 NPI number — SHIPPENVILLE ELK TOWNSHIP VOLUNT

Table of content: (NPI 1497741466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497741466 NPI number — SHIPPENVILLE ELK TOWNSHIP VOLUNT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIPPENVILLE ELK TOWNSHIP VOLUNT
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:
6
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:
1497741466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18105-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-473-2278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPPENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16254-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-782-6245
Provider Business Practice Location Address Fax Number:
814-782-3327
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JEANNERAT
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
814-782-6245

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03021 , 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: 0012691900004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282131 . This is a "BCBS OF PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590010198 . This is a "UNITED HC RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000 . This is a "NY DPA COMPUTER SCIENCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000 . This is a "NY EMPIRE MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 081243600 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com