Basic Information
Provider Information | |||||||||
NPI: | 1649227166 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | APOGEE MEDICAL GROUP OF PENNSYLVANIA PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 708610 | ||||||||
Address2: |   | ||||||||
City: | SANDY | ||||||||
State: | UT | ||||||||
PostalCode: | 840708610 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8013529500 | ||||||||
FaxNumber: | 8013527976 | ||||||||
Practice Location | |||||||||
Address1: | 15059 N SCOTTSDALE ROAD | ||||||||
Address2: | SUITE 600 | ||||||||
City: | SCOTTSDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 852542685 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6027783600 | ||||||||
FaxNumber: | 6027783695 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/29/2006 | ||||||||
LastUpdateDate: | 05/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HARWELL | ||||||||
AuthorizedOfficialFirstName: | KAREN | ||||||||
AuthorizedOfficialMiddleName: | J. | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 6027783600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1011845690001 | 05 | PA |   | MEDICAID | 20037109 | 05 | PA |   | MEDICAID | 30018965 | 05 | PA |   | MEDICAID | DC3214 | 01 | PA | RR MEDICARE-COATESVILLE | OTHER | 1681330 | 01 | PA | BCBS HIGHMARK | OTHER | 50015794 | 01 | PA | CAPITAL BCBS | OTHER | DD7712 | 01 | PA | RR MEDICARE-EASTON | OTHER | 2359339000 | 01 | PA | INDEPENDENCE BCBS | OTHER |