Provider Demographics
NPI:1518307982
Name:BUTLER MEDICAL PROVIDERS
Entity Type:Organization
Organization Name:BUTLER MEDICAL PROVIDERS
Other - Org Name:BHS WOUND CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFURIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-284-4408
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 1:102 TECHNOLOGY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1784
Practice Address - Country:US
Practice Address - Phone:724-482-0191
Practice Address - Fax:724-482-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077561OtherMEDICARE GROUP NUMBER