1770675977 NPI number — BUTLER MEDICAL PROVIDERS

Table of content: (NPI 1770675977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770675977 NPI number — BUTLER MEDICAL PROVIDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUTLER MEDICAL PROVIDERS
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:
1770675977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-284-4084
Provider Business Mailing Address Fax Number:
724-284-4144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1022B N MAIN STREET EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-1954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-995-0115
Provider Business Practice Location Address Fax Number:
724-282-0675
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADDEN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
COO PHYSICIAN NETWORK
Authorized Official Telephone Number:
724-283-6666

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0016445210017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016445210019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016445210077 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016445210078 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com