1720052491 NPI number — ALLYSON LEIGH SKEBE PA-C

Table of content: ALLYSON LEIGH SKEBE PA-C (NPI 1720052491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720052491 NPI number — ALLYSON LEIGH SKEBE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKEBE
Provider First Name:
ALLYSON
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRINDA
Provider Other First Name:
ALLYSON
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720052491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3755 ORANGE PL STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-746-8537
Provider Business Mailing Address Fax Number:
216-450-1810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3755 ORANGE PL STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-746-8537
Provider Business Practice Location Address Fax Number:
216-450-1810
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  50.002696RX , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0068424 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6184581 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9177119 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: CS1711001157 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P01827113 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H081972 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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