1760492672 NPI number — PA ARTIFICIAL LIMB & BRACE CO., INC

Table of content: (NPI 1760492672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760492672 NPI number — PA ARTIFICIAL LIMB & BRACE CO., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PA ARTIFICIAL LIMB & BRACE CO., INC
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:
1760492672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 W 26TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16508-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-868-5231
Provider Business Mailing Address Fax Number:
814-868-5232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4859 N RIDGE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHTABULA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44004-9409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-969-1144
Provider Business Practice Location Address Fax Number:
814-868-5232
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
814-868-5231

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: LPO-294 , 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: 0342212 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 287952 . This is a "HIGHMARK" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 8675613 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 219593 . This is a "UPMC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 000000154842 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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