1760559801 NPI number — AUSTIN LANE SEDICUM III DPM

Table of content: AUSTIN LANE SEDICUM III DPM (NPI 1760559801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760559801 NPI number — AUSTIN LANE SEDICUM III DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEDICUM
Provider First Name:
AUSTIN
Provider Middle Name:
LANE
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1760559801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 S WEST END BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUAKERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-529-6511
Provider Business Mailing Address Fax Number:
215-529-6512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 S WEST END BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUAKERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-529-6511
Provider Business Practice Location Address Fax Number:
215-529-6512
Provider Enumeration Date:
11/30/2006

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: 213E00000X , with the licence number:  SC005511 , 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: 2941264 . This is a "AETNA HMO PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1418639 . This is a "BS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063479Q2K . This is a "MEDICARE INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2103588000 . This is a "KEYSTONE INDIVIDUAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7802379 . This is a "AETNA PPO PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50010317 . This is a "CAPITAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063480 . This is a "MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50016192 . This is a "CAPITAL INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2105345000 . This is a "KEYSTONE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417165 . This is a "BS INDIVIDUAL" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com