Provider Demographics
NPI:1073588570
Name:NEB DOCTORS OF WESTERN PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:NEB DOCTORS OF WESTERN PENNSYLVANIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-200-2105
Mailing Address - Street 1:850 BOYCE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1541
Mailing Address - Country:US
Mailing Address - Phone:412-653-3750
Mailing Address - Fax:
Practice Address - Street 1:850 BOYCE RD STE 5
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1541
Practice Address - Country:US
Practice Address - Phone:412-653-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006759332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014822660001Medicaid
PA5540340001Medicare NSC