Provider Demographics
NPI:1619493046
Name:BUTLER MEDICAL PROVIDERS
Entity Type:Organization
Organization Name:BUTLER MEDICAL PROVIDERS
Other - Org Name:BHS BENBROOK GASTROENTEROLOGY ASSOCIATES
Other - Org Type:Other Name
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:724-283-6666
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 1:104 TECHNOLOGY DR STE 202
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1801
Practice Address - Country:US
Practice Address - Phone:833-391-0654
Practice Address - Fax:724-482-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001644521-0017Medicaid