1619080660 NPI number — FRANK A REZK

Table of content: (NPI 1619080660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619080660 NPI number — FRANK A REZK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK A REZK
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:
PENN HOME MEDICAL SUPPLY CO.,LLC
Provider Other Organization Name Type Code:
3
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:
1619080660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
657 INDUSTRIAL PARK RD
Provider Second Line Business Mailing Address:
PO BOX 337
Provider Business Mailing Address City Name:
EBENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15931-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-471-0627
Provider Business Mailing Address Fax Number:
814-471-0639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1704 PHILADELPHIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHERN CAMBRIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15714-1180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-948-2058
Provider Business Practice Location Address Fax Number:
814-948-7139
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REZK
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
814-471-0627

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1505986 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1535665 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 152805 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 297884 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017226640002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040020700 . This is a "DOL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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