1811304165 NPI number — KENDALL HINZE

Table of content: KENDALL HINZE (NPI 1811304165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811304165 NPI number — KENDALL HINZE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINZE
Provider First Name:
KENDALL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1811304165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4460 PARK VIEW DR
Provider Second Line Business Mailing Address:
APT V-2
Provider Business Mailing Address City Name:
SCHNECKSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18078-2579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-602-6910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 N 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-4262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP448631 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RPI008518 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: RP448631 . This is a "PA STATE BOARD OF PHARMACY" identifier . This identifiers is of the category "OTHER".
  • Identifier: RPI008518 . This is a "PA STATE BOARD OF PHARMACY" identifier . This identifiers is of the category "OTHER".