Provider Demographics
NPI:1790024867
Name:R SAMUEL MAGEE MD FACS PC
Entity Type:Organization
Organization Name:R SAMUEL MAGEE MD FACS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-964-0691
Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:SUITE B109
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4810
Mailing Address - Country:US
Mailing Address - Phone:814-946-0891
Mailing Address - Fax:814-949-9192
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:SUITE B109
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-946-0891
Practice Address - Fax:814-949-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007717920003AMedicaid
PA1700947504OtherNPI
PAD69948Medicare UPIN
PA1700947504OtherNPI