1578550307 NPI number — BARTH ORTHOTIC AND PROSTHETIC SERVICES, P.C,

Table of content: (NPI 1578550307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578550307 NPI number — BARTH ORTHOTIC AND PROSTHETIC SERVICES, P.C,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARTH ORTHOTIC AND PROSTHETIC SERVICES, P.C,
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:
1578550307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 W CARPENTER ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62702-4922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-789-1450
Provider Business Mailing Address Fax Number:
217-789-1454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 W CARPENTER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62702-4922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-789-1450
Provider Business Practice Location Address Fax Number:
217-789-1454
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
503-493-8288

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0008432043 . This is a "BLUE CROSS BLUE SHIELD IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 322465121001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 361442736001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174655 . This is a "PERSONAL CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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