1871683573 NPI number — JOHN MITCHELL MD PC

Table of content: (NPI 1871683573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871683573 NPI number — JOHN MITCHELL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN MITCHELL MD 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:
1871683573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 N CEDAR CREST BLVD STE 502
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-2355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-351-0625
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 N CEDAR CREST BLVD STE 502
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-351-0625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEIP
Authorized Official First Name:
JOY
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
610-351-0625

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  397040 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 213680 , 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: 1862 . This is a "HIGHMARK BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 390766 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A926 . This is a "AMERIHEALTH ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881742377 . This is a "CBC, HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2181265 . This is a "CIGNA BEH HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 476535 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 014261 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0014259640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102791000 . This is a "MAGELLAN BEH HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: A3159040 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002391000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008496118 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1861 . This is a "HIGHMARK BS" identifier . This identifiers is of the category "OTHER".




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