1629449996 NPI number — BASH FAMILY PRACTICE

Table of content: (NPI 1629449996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629449996 NPI number — BASH FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASH FAMILY PRACTICE
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:
1629449996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 MOORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 S DUFFY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-285-1988
Provider Business Practice Location Address Fax Number:
724-256-8752
Provider Enumeration Date:
10/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BASH
Authorized Official First Name:
BETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CRNP
Authorized Official Telephone Number:
724-285-1988

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  TP005043B , 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)





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