NPIMap

Organization Active NPI

Your Neighborhood Doc PC

  • Primary Care Clinic/Center
  • Kane, PA
National Provider Identifier
1336335090
Registry record updated Nov 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
MD037007L Issued in PA
Legal business name
YOUR NEIGHBORHOOD DOC PC
Practice address
38 Thompson Park
Kane, PA 16735-0399
Phone
(814) 837-9841
Fax
(814) 837-6494
NPI assigned
Sep 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2007

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

Authorized official

Name
Dr. Emmanuel Fermin Hipolito Jr., M.D.
Title
Owner
Phone
(814) 837-9841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X MD037007L PA Primary

Addresses

Primary practice location

38 Thompson Park
Kane, PA 16735-0399

Mailing address

P O Box 399
38 Thompson Park
Kane, PA 16735-0399
Phone (814) 837-9841

Other identifiers 1

IdentifierTypeStateIssuer
1630113OtherPABLUE SHIELD

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194480000000",
    "number": "1336335090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 399",
            "address_2": "38 THOMPSON PARK",
            "city": "KANE",
            "state": "PA",
            "postal_code": "167350399",
            "telephone_number": "814-837-9841",
            "fax_number": "814-837-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 THOMPSON PARK",
            "city": "KANE",
            "state": "PA",
            "postal_code": "167350399",
            "telephone_number": "814-837-9841",
            "fax_number": "814-837-6494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR NEIGHBORHOOD DOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2007-11-08",
        "status": "A",
        "authorized_official_last_name": "HIPOLITO",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "FERMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-837-9841",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "MD037007L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1630113",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kane, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; 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.