1780740233 NPI number — JOHN C. MACAULAY & JOSEPHINE C. KINNEY

Table of content: (NPI 1780740233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780740233 NPI number — JOHN C. MACAULAY & JOSEPHINE C. KINNEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN C. MACAULAY & JOSEPHINE C. KINNEY
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:
1780740233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 LANCASTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-296-5560
Provider Business Mailing Address Fax Number:
610-296-5560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALVERN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19355-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-296-5560
Provider Business Practice Location Address Fax Number:
610-296-5560
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACAULAY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
610-296-5560

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WH116221 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 0274895000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: WH116221 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4488453 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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