1972569911 NPI number — JACK L ARMSTRONG MD

Table of content: JACK L ARMSTRONG MD (NPI 1972569911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972569911 NPI number — JACK L ARMSTRONG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
JACK
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1972569911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 BENT CREEK BLVD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050-1870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-791-2640
Provider Business Mailing Address Fax Number:
717-791-2646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 BENT CREEK BLVD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-243-7540
Provider Business Practice Location Address Fax Number:
717-243-9968
Provider Enumeration Date:
04/26/2006

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: 207K00000X , with the licence number:  MD069595L , 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: 001766560 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1520984 . This is a "GATEWAY IND" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 696513 . This is a "HIGHMARK BLUE SHIELD IND" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02047901 . This is a "CAPITAL BLUE CROSS IND" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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