1770762213 NPI number — ANCHOR HEALTH CENTERS PA

Table of content: (NPI 1770762213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770762213 NPI number — ANCHOR HEALTH CENTERS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANCHOR HEALTH CENTERS PA
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:
1770762213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10661 AIRPORT PULLING RD N
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34109-7335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-430-2929
Provider Business Mailing Address Fax Number:
239-430-2934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10661 AIRPORT PULLING RD N
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34109-7335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-430-2929
Provider Business Practice Location Address Fax Number:
239-430-2934
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CENTRAL BILLING MANAGER
Authorized Official Telephone Number:
239-436-2839

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40916K . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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