1265410153 NPI number — DR. VINCENT JOSEPH SPELLANE DPT,CSCS,CWT,BS,AS

Table of content: DR. VINCENT JOSEPH SPELLANE DPT,CSCS,CWT,BS,AS (NPI 1265410153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265410153 NPI number — DR. VINCENT JOSEPH SPELLANE DPT,CSCS,CWT,BS,AS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPELLANE
Provider First Name:
VINCENT
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT,CSCS,CWT,BS,AS
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:
1265410153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 STEELE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALTSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15681-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-972-7137
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1176 MANSFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-357-9991
Provider Business Practice Location Address Fax Number:
724-357-9993
Provider Enumeration Date:
01/03/2006

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: 225100000X , with the licence number:  PT017569 , 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: 1748120 . This is a "HIGHMARK BC BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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