1346337508 NPI number — HORODNIC FAMILY MEDICINE, LLC

Table of content: (NPI 1346337508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346337508 NPI number — HORODNIC FAMILY MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORODNIC FAMILY MEDICINE, LLC
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:
1346337508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 N MEADOWS DR
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-8369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-934-5040
Provider Business Mailing Address Fax Number:
724-934-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 N MEADOWS DR
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-8369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-934-5040
Provider Business Practice Location Address Fax Number:
724-934-5051
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORODNIC
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-934-5040

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0015470360014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com