Provider Demographics
NPI:1306879861
Name:CEDAR CREST EMERGICENTER
Entity type:Organization
Organization Name:CEDAR CREST EMERGICENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SHINGLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-435-3111
Mailing Address - Street 1:1101 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7902
Mailing Address - Country:US
Mailing Address - Phone:610-435-3111
Mailing Address - Fax:
Practice Address - Street 1:1101 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7902
Practice Address - Country:US
Practice Address - Phone:610-435-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC8556OtherRAILROAD MEDICARE
PA02371000OtherCAPITAL BLUE CROSS
PA462851OtherHIGHMARK BLUE SHIELD
PA0041290002OtherINDEPENDENCE BLUE CROSS
PA0041290002OtherINDEPENDENCE BLUE CROSS