1982699989 NPI number — MRS. STACEY L HUMES OTR L

Table of content: MRS. STACEY L HUMES OTR L (NPI 1982699989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982699989 NPI number — MRS. STACEY L HUMES OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMES
Provider First Name:
STACEY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR L
Provider Gender Code:
F

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:
1982699989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENOLA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17025-0023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-877-8811
Provider Business Mailing Address Fax Number:
717-732-0178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 WALNUT BOTTOM RD STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-877-8811
Provider Business Practice Location Address Fax Number:
717-918-5745
Provider Enumeration Date:
09/15/2005

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: 225XH1200X , with the licence number:  7472 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OC002500L , 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: 3571011 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50012506 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7600575 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 76210 . This is a "HEALTH AMERICA COVENTRY H" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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