1972649556 NPI number — NANTICOKE SURGICAL ASSOCIATES, P.A.

Table of content: (NPI 1972649556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972649556 NPI number — NANTICOKE SURGICAL ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANTICOKE SURGICAL ASSOCIATES, P.A.
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:
1972649556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
543 N SHIPLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEAFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19973-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-629-8662
Provider Business Mailing Address Fax Number:
302-629-7661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 N SHIPLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19973-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-629-8662
Provider Business Practice Location Address Fax Number:
302-629-7661
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARES
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-629-8662

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  1989027203 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 99032 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000137502 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0108680000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: CE2117 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 487744 . This is a "AMERIHEALTH PERSONAL CHOI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 792499 . This is a "MDIPA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com