Idp Punxsutawney LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS018913L Issued in PA

Legal business name

IDP PUNXSUTAWNEY LLC

Practice address

219 N Main St
Punxsutawney, PA 15767-1217

Phone

(814) 938-2222

Fax

(814) 938-0931

NPI assigned

Jul 29, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Julie Smith

Title

Operations Facilitator

Phone

(231) 739-5105

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• John Regis Smelko Former legal business name

Locations

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

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375056000000",
    "number": "1245672419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 N MAIN ST",
            "city": "PUNXSUTAWNEY",
            "state": "PA",
            "postal_code": "157671217",
            "telephone_number": "814-938-2222",
            "fax_number": "814-938-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 N MAIN ST",
            "city": "PUNXSUTAWNEY",
            "state": "PA",
            "postal_code": "157671217",
            "telephone_number": "814-938-2222",
            "fax_number": "814-938-0931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDP PUNXSUTAWNEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-29",
        "last_updated": "2013-07-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OPERATIONS FACILITATOR",
        "authorized_official_telephone_number": "231-739-5105",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS018913L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006936660001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John Regis Smelko",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mitchell Hogue
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• Michael Joseph Horner, RPH
• Andrea Lynn Huffman
• Janet E Huot, R.D.,C.D.E.
• Independent Developmental Assessmen
• Indiana Healthcare Physician Services Inc (Punxsutawney Physician Group - Rapid Care)
• Indiana Healthcare Physician Services, Inc (D/B/A Punxsutawney Physician Group)
• Allison Marie Ishman
• Morgan A Janocha

• General Practice Dentistry in Punxsutawney, PA
• Providers in Punxsutawney, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.