Organization Name: | MAINLINE MEDICAL ASSOCIATES, INC. |
NPI Number: | 1205977642 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNY HEINE (DIR. OF OPERATIONS) |
Mailing Address: | 792 Gallitzin Rd Cresson |
State: | PA US |
Postal Code: | 166302213 |
Phone Number: | 8148868161 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 10/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332900000X |
License Number: | MD023791E |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Non-Pharmacy Dispensing Site |
Taxonomy Specialization: | |
Taxonomy Definition: | A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |