NPIMap

Organization Active NPI

Centre County MH-Id-Ei/D&a

  • Case Manager/Care Coordinator
  • State College, PA
National Provider Identifier
1902026099
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
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) 355-6782
Fax
(814) 355-6985
NPI assigned
Apr 30, 2007
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 Manager/Care CoordinatorGroup: 193400000X SINGLE SPECIALTY GROUP 171M00000X 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) 355-6782

Other identifiers 1

IdentifierTypeStateIssuer
1007296630003MedicaidPA

Other names 1

  • EI 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.

NPI Registry JSON

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1902026099",
    "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": "814-355-6782",
            "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": "814-355-6782",
            "fax_number": "814-355-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRE COUNTY MH-ID-EI/D&A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "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": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007296630003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EI",
            "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.