1740329218 NPI number — RAYSTOWN PODIATRY ASSOCIATES

Table of content: (NPI 1740329218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740329218 NPI number — RAYSTOWN PODIATRY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYSTOWN PODIATRY 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:
1740329218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16652-1826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-643-5565
Provider Business Mailing Address Fax Number:
814-643-2607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-5565
Provider Business Practice Location Address Fax Number:
814-643-2607
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOOVER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-643-5193

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  SC001976-L , 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)

  • Identifier: 1295443 . This is a "AAG BENEFIT PLAN ADMINIST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 50001941 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 21298 . This is a "GEISSINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004390700 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 335768 . This is a "HEALTH AMERICA PENNSYLVAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 25363650 . This is a "PENN TREATY NETWORK AM IN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 338060 . This is a "COMBINED INSURANCE CO OF" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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