Provider Demographics
NPI:1598883332
Name:JEFFREY J BACKENSTOES DO PC
Entity Type:Organization
Organization Name:JEFFREY J BACKENSTOES DO PC
Other - Org Name:CAPSTONE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BACKENSTOES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-695-6177
Mailing Address - Street 1:4807 JONESTOWN RD STE 141
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1744
Mailing Address - Country:US
Mailing Address - Phone:717-695-6177
Mailing Address - Fax:717-695-4369
Practice Address - Street 1:4807 JONESTOWN RD STE 141
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1744
Practice Address - Country:US
Practice Address - Phone:717-695-6177
Practice Address - Fax:717-695-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008959-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG45914Medicare UPIN
PA898424Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER