1710932322 NPI number — GYNO ASSOCIATES

Table of content: (NPI 1710932322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710932322 NPI number — GYNO ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GYNO ASSOCIATES
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:
1710932322
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:
1010 LIGONIER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATROBE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15650-1882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-539-8581
Provider Business Mailing Address Fax Number:
724-539-1575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 LIGONIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATROBE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15650-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-539-8581
Provider Business Practice Location Address Fax Number:
724-539-1575
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAXWELL
Authorized Official First Name:
BETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-539-8581

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007444810006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007444810005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 067988 . This is a "BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1006226 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 63093 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: V02311 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 023111 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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