NPIMap

Organization Active NPI

The Salvation Army

  • Dentist
  • Johnstown, PA
National Provider Identifier
1659706166
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS025867L Issued in PA
Legal business name
THE SALVATION ARMY
Practice address
647 Main Street
PO Box 968
Johnstown, PA 15907-0968
Phone
(814) 539-3110
Fax
(814) 536-4785
NPI assigned
Sep 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Michael John Southwick
Title
Secretary
Phone
(845) 620-7329

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DS025867L PA Primary
Voluntary or Charitable Agency 251V00000X

Addresses

Primary practice location

647 Main Street
PO Box 968
Johnstown, PA 15907-0968

Mailing address

440 W Nyack Rd
West Nyack, NY 10994-1753
Phone (845) 620-7200

Other identifiers 1

IdentifierTypeStateIssuer
0011051320005MedicaidPA

Other names 1

  • The Salvation Army - Dental Center of Johnstown Other name

National Provider Directory

National Provider Directory
Tax ID family
The Salvation Army Harbor Light Center Beacon Program16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1659706166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W NYACK RD",
            "city": "WEST NYACK",
            "state": "NY",
            "postal_code": "109941753",
            "telephone_number": "845-620-7200",
            "fax_number": "845-620-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 MAIN STREET",
            "address_2": "PO BOX 968",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159070968",
            "telephone_number": "814-539-3110",
            "fax_number": "814-536-4785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SALVATION ARMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SOUTHWICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "845-620-7329",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS025867L",
            "primary": true
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011051320005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Salvation Army - Dental Center of Johnstown",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Johnstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.