1760521611 NPI number — MED HEALTH SERVICES MANAGEMENT, LP

Table of content: (NPI 1760521611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760521611 NPI number — MED HEALTH SERVICES MANAGEMENT, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED HEALTH SERVICES MANAGEMENT, LP
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:
1760521611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 JAMES PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-373-7900
Provider Business Mailing Address Fax Number:
412-372-1645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 JAMES PL
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-373-7900
Provider Business Practice Location Address Fax Number:
412-372-1645
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KONDEL
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
800-443-2035

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  39D0176771 , 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: 2042873 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810013048 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14304450011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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