Provider Demographics
NPI:1366835167
Name:BUTLER MEDICAL PROVIDERS
Entity Type:Organization
Organization Name:BUTLER MEDICAL PROVIDERS
Other - Org Name:BHS PRIMARY CARE - NEW CASTLE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEWKSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-284-4347
Mailing Address - Street 1:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1549
Mailing Address - Country:US
Mailing Address - Phone:724-284-4060
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:2602 WILMINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1539
Practice Address - Country:US
Practice Address - Phone:833-391-0736
Practice Address - Fax:724-856-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034790Medicare Oscar/Certification