1467488445 NPI number — BERT J ALTMANSHOFER DPM

Table of content: BERT J ALTMANSHOFER DPM (NPI 1467488445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467488445 NPI number — BERT J ALTMANSHOFER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALTMANSHOFER
Provider First Name:
BERT
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1467488445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLIDAYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16648-0412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-696-3397
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1798 OLD ROUTE 220 N
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
DUNCANSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16635-8341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-696-3397
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2006

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: 213ES0103X , with the licence number:  SC002818L , 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: 145696H59 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 681677 . This is a "ADVANTRA FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 316039 . This is a "HEALTHAMERI HEALTHASSURAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145696 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200088 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 242968 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2958931 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 242968 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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