1649305293 NPI number — SAINT CATHERINE PHYSICIAN SERVICES PCP OF PENNSYLVANIA

Table of content: (NPI 1649305293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649305293 NPI number — SAINT CATHERINE PHYSICIAN SERVICES PCP OF PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT CATHERINE PHYSICIAN SERVICES PCP OF PENNSYLVANIA
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:
1649305293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17921-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-875-6815
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 SHENANDOAH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RINGTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17967-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-889-3103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOOVER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
570-875-2000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50064687 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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