1508097411 NPI number — ONSIGHT HEALTH CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508097411 NPI number — ONSIGHT HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONSIGHT HEALTH CARE LLC
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:
1508097411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12910 SHELBYVILLE RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-813-4415
Provider Business Mailing Address Fax Number:
502-996-8282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2595 INTERSTATE DR STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-9378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-2420
Provider Business Practice Location Address Fax Number:
502-996-8282
Provider Enumeration Date:
07/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FELTZ
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
614-895-7280

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG002019 , 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: 102372661 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002143462 . This is a "HIGHMARK MEDICARE ADVANTAGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 002143462 . This is a "KEYSTONE HEALTH PLAN WEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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