NPIMap

Organization Active NPI

Deer Lakes Medical Association

  • Non-Pharmacy Dispensing Site
  • Cheswick, PA
National Provider Identifier
1831239532
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD053615L Issued in PA
Legal business name
DEER LAKES MEDICAL ASSOCIATION
Practice address
221 Russellton Dorseyville Rd
Cheswick, PA 15024-2004
Phone
(412) 767-5387
NPI assigned
Feb 8, 2007
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Mr. Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD053615L PA Primary

Addresses

Primary practice location

221 Russellton Dorseyville Rd
Cheswick, PA 15024-2004

Mailing address

5810 Nancy Ridge Dr
San Diego, CA 92121-2834
Phone (858) 625-2990

Other names 1

  • Deer Lakes Medical Association - Cheswick Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Deer Lakes Medical Association4 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1831239532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 NANCY RIDGE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212834",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 RUSSELLTON DORSEYVILLE RD",
            "city": "CHESWICK",
            "state": "PA",
            "postal_code": "150242004",
            "telephone_number": "412-767-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER LAKES MEDICAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-08",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD053615L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deer Lakes Medical Association - Cheswick",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheswick, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.