NPIMap

Organization Active NPI

Centre County MH-Id-Ei/D&a

  • Case Management Agency
  • State College, PA
National Provider Identifier
1386626273
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
CENTRE COUNTY MH-ID-EI/D&A
Practice address
3500 E College Ave
Suite 1200
State College, PA 16801-7569
Phone
(814) 355-6786
Fax
(814) 355-6985
NPI assigned
Nov 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2015

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

Authorized official

Name
Thomas J McDermott
Title
Administrator
Phone
(814) 355-6782

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

3500 E College Ave
Suite 1200
State College, PA 16801-7569

Mailing address

3500 E College Ave
Suite 1200
State College, PA 16801-7569
Phone (814) 355-6786

Other identifiers 1

IdentifierTypeStateIssuer
1007296630004MedicaidPA

Other names 1

  • TSM Other name

National Provider Directory

National Provider Directory
Tax ID family
Centre County MH-Id-Eida7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

3500 E College Ave
Ste 1200
State College, PA 16801
Phone (814) 355-6782

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1386626273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 E COLLEGE AVE",
            "address_2": "SUITE 1200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017569",
            "telephone_number": "814-355-6786",
            "fax_number": "814-355-6985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 E COLLEGE AVE",
            "address_2": "SUITE 1200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017569",
            "telephone_number": "814-355-6786",
            "fax_number": "814-355-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRE COUNTY MH-ID-EI/D&A",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "814-355-6782"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007296630004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TSM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.