1770550352 NPI number — LATROBE SURGICAL GROUP LLC

Table of content: (NPI 1770550352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770550352 NPI number — LATROBE SURGICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LATROBE SURGICAL GROUP LLC
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:
1770550352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
443 FRYE FARM ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-537-7100
Provider Business Mailing Address Fax Number:
724-537-9847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
443 FRYE FARM ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-537-7100
Provider Business Practice Location Address Fax Number:
724-537-9847
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PENROD
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
724-537-7100

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , 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: 125680 . This is a "HEALTH AMERICA/ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 342220 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 108268 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7123139 . This is a "AETNA NON-HMO" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 2348044 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018040440002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1510692 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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