1629089578 NPI number — QUAKER STATE MEDICAL SERVICES CO INC

Table of content: MR. PAUL CHRISTOPHER GILLILAND LCSW (NPI 1013247535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629089578 NPI number — QUAKER STATE MEDICAL SERVICES CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUAKER STATE MEDICAL SERVICES CO INC
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:
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:
1629089578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 CONSTITUTION DR
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-458-9250
Provider Business Mailing Address Fax Number:
610-458-9207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 CONSTITUTION DR
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-458-9250
Provider Business Practice Location Address Fax Number:
610-458-9207
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLAY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-458-9250

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHC065 . This is a "PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com