1821039132 NPI number — PROFESSIONAL PROVIDERS INC

Table of content: AMANDA LIMON (NPI 1508318429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821039132 NPI number — PROFESSIONAL PROVIDERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL PROVIDERS INC
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:
1821039132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1244 W CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 409
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19382-5657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-738-8016
Provider Business Mailing Address Fax Number:
610-918-6316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 E UWCHLAN AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-363-1995
Provider Business Practice Location Address Fax Number:
610-363-1995
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEBOUTILLIER
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
610-738-8016

Provider Taxonomy Codes

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

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





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