NPIMap

Organization Active NPI

John R Slagle

  • Community/Retail Pharmacy
  • Waterford, PA
National Provider Identifier
1124112644
Registry record updated Jul 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP415468L Issued in PA
Legal business name
JOHN R SLAGLE
Practice address
216 High St
Waterford, PA 16441
Phone
(814) 796-6655
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Slagle, RPH
Title
Owner
Phone
(814) 796-5555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PP415468L PA Primary

Addresses

Primary practice location

216 High St
Waterford, PA 16441

Mailing address

216 High St
Waterford, PA 16441

Other identifiers 1

IdentifierTypeStateIssuer
10077242210002MedicaidPA

Other names 1

  • waterford pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100222000825 PA Part B Supplier - Mass Immunization (Roster Biller Only) 9335283837 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarion, PA; Sheffield, PA; Tionesta, PA; Waterford, PA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
John R Slagle5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1124112644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 HIGH ST",
            "city": "WATERFORD",
            "state": "PA",
            "postal_code": "16441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 HIGH ST",
            "city": "WATERFORD",
            "state": "PA",
            "postal_code": "16441",
            "telephone_number": "814-796-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN R SLAGLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "SLAGLE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-796-5555",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP415468L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10077242210002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "waterford pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waterford, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.