1063700425 NPI number — LANGHORNE PHYSICIAN SERVICES

Table of content: (NPI 1063700425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063700425 NPI number — LANGHORNE PHYSICIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANGHORNE PHYSICIAN SERVICES
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:
6
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:
1063700425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 CORPORATE DR W
Provider Second Line Business Mailing Address:
LUXEMBOURG CORPORATE CENTER
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-8011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-860-4380
Provider Business Mailing Address Fax Number:
215-968-5918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 CORPORATE DR W
Provider Second Line Business Practice Location Address:
LUXEMBOURG CORPORATE CENTER
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-8011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-860-4380
Provider Business Practice Location Address Fax Number:
215-968-5918
Provider Enumeration Date:
07/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KOSYLA
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP/CFO
Authorized Official Telephone Number:
215-710-6566

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD007527E , 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: 001463820 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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