1588897326 NPI number — MR. PATRICK E HEAGEY PA

Table of content: MR. PATRICK E HEAGEY PA (NPI 1588897326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588897326 NPI number — MR. PATRICK E HEAGEY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEAGEY
Provider First Name:
PATRICK
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

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:
1588897326
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/08/2009
NPI Reactivation Date:
09/25/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 SYCAMORE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-476-9682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 W LANCASTER AVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-565-1043
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  MA054099 , 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)