Provider Demographics
NPI:1588709331
Name:BUTLER MEDICAL PROVIDERS
Entity type:Organization
Organization Name:BUTLER MEDICAL PROVIDERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-284-4879
Mailing Address - Street 1:PO BOX 1549
Mailing Address - Street 2:SUITE 801
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1549
Mailing Address - Country:US
Mailing Address - Phone:724-284-4084
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:911 E BRADY ST
Practice Address - Street 2:3X
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4646
Practice Address - Country:US
Practice Address - Phone:724-284-4612
Practice Address - Fax:724-284-4774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUTLER MEDICAL PROVIDERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016445210035Medicaid
PA1850233OtherHIGHMARK
PA1850233OtherHIGHMARK