1760581581 NPI number — READING ORAL SURGERY GROUP, LTD

Table of content: (NPI 1760581581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760581581 NPI number — READING ORAL SURGERY GROUP, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
READING ORAL SURGERY GROUP, LTD
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:
1760581581
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:
517 E LANCASTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHILLINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19607-1364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-777-7646
Provider Business Mailing Address Fax Number:
610-777-7570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
517 E LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHILLINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19607-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-777-7646
Provider Business Practice Location Address Fax Number:
610-777-7570
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
610-777-7646

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0005247430001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 039397 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02979300 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005247430002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18602 . This is a "HEALTH AM/HEALTH ASSURANC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".