1225067424 NPI number — EXECUTIVE HEALTH RESOURCES CLINICAL STAFFING SOLUTIONS PC

Table of content: (NPI 1225067424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225067424 NPI number — EXECUTIVE HEALTH RESOURCES CLINICAL STAFFING SOLUTIONS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXECUTIVE HEALTH RESOURCES CLINICAL STAFFING SOLUTIONS 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:
1225067424
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:
15 CAMPUS BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NEWTOWN SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19073-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-454-6268
Provider Business Mailing Address Fax Number:
610-789-6158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 CAMPUS BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NEWTOWN SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19073-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-454-6268
Provider Business Practice Location Address Fax Number:
610-789-6158
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORRATO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
484-454-6262

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1660744 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012282060001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com