1801961610 NPI number — SPINAL HEALTH AND WELLNESS CENTER, LLC

Table of content: (NPI 1801961610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801961610 NPI number — SPINAL HEALTH AND WELLNESS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINAL HEALTH AND WELLNESS CENTER, 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:
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:
1801961610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 EXECUTIVE DR
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
CRANBERRY TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066-6442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-742-1777
Provider Business Mailing Address Fax Number:
724-742-1780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CRANBERRY TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-6442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-742-1777
Provider Business Practice Location Address Fax Number:
724-742-1780
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
JEANETTE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-742-1777

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009032 , 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: 5644102 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1527835 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3312788 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4070935 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1049160 . This is a "AMERICAN SPECIALY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 554942 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 400602 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com