Basic Information
| Provider Information | |||||||||
| NPI: | 1023478237 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUTLER MEDICAL PROVIDERS | ||||||||
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| OtherOrganizationName: | BHS ENDOCRINOLOGY ASSOCIATES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1549 | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160031549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242845670 | ||||||||
| FaxNumber: | 7242844144 | ||||||||
| Practice Location | |||||||||
| Address1: | 127 ONEIDA VALLEY RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160012246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8336047211 | ||||||||
| FaxNumber: | 7242851274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2016 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | TEWKSBURY | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE BMP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 7242844347 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0013445210017 | 05 | PA | MEDICAID |