1578507521 NPI number — DR. DENNIS LEE ECKELS D.O., F.A.A.F.P.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578507521 NPI number — DR. DENNIS LEE ECKELS D.O., F.A.A.F.P.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ECKELS

Provider First Name:

DENNIS

Provider Middle Name:

LEE

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.O., F.A.A.F.P.

Provider Gender Code:

M

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:

1578507521

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/30/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 486

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SEWARD

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

15954-0486

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

814-446-5695

Provider Business Mailing Address Fax Number:

814-446-4209

Provider First Line Business Practice Location Address:

238 INDIANA ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SEWARD

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

15954-2055

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

814-446-5695

Provider Business Practice Location Address Fax Number:

814-446-4209

Provider Enumeration Date:

06/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  OS-003436-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 4556169 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 56-24-90789 . This is a "TAX ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P00209792 . This is a "MEDICARE RAILROAD INDIVID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 56-2490789 . This is a "UMWA ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: OS-003436-L . This is a "PA STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 00150773800/01 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 255520 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: DD1268 . This is a "MEDICARE RAILROAD GROUP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 01586199 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 100236 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 207QOOOOOX . This is a "TAXONOMY CODE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".