1881772036 NPI number — ELIZABETH TOWNSHIP FAMILY MEDICINE, PC

Table of content: (NPI 1881772036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881772036 NPI number — ELIZABETH TOWNSHIP FAMILY MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZABETH TOWNSHIP FAMILY MEDICINE, 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:
1881772036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SCENERY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15037-2051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-751-4661
Provider Business Mailing Address Fax Number:
412-751-8811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SCENERY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15037-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-751-4661
Provider Business Practice Location Address Fax Number:
412-751-8811
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORALCZYK
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
412-751-4661

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102273 . This is a "DR SKINNER UPMCHP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102594 . This is a "DR GORALCZYK UPMCHP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000136532 . This is a "DR SKINNER HIGHMARK #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007335100005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 750D . This is a "UPMC HEALTH PLAN GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000059418 . This is a "DR GORALCZYK HIGHMARK #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001636633 . This is a "HIGHMARK GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007335470005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011166490001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 244337 . This is a "HEALTH AMERICA GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com