1710958475 NPI number — FOCUSEDHEALTH PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710958475 NPI number — FOCUSEDHEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOCUSEDHEALTH PC
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:
6
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:
1710958475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-286-9064
Provider Business Mailing Address Fax Number:
610-286-7832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4103 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELVERSON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-286-9064
Provider Business Practice Location Address Fax Number:
610-286-7832
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONALDSON
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-286-9064

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1310236 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DG2978 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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