1831210145 NPI number — JAMES R. GEBHART, D.O., PC

Table of content: (NPI 1831210145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831210145 NPI number — JAMES R. GEBHART, D.O., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES R. GEBHART, D.O., PC
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:
1831210145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 GARDEN WAY
Provider Second Line Business Mailing Address:
SUITE 100B
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16148-5215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-981-4190
Provider Business Mailing Address Fax Number:
724-981-6317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 GARDEN WAY
Provider Second Line Business Practice Location Address:
SUITE 100B
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-981-4190
Provider Business Practice Location Address Fax Number:
724-981-6317
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEBHART
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-981-4190

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  OS007886L , 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: 0012934350002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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