Provider Demographics
NPI:1790769610
Name:AP02 INC
Entity Type:Organization
Organization Name:AP02 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT APO2
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAVLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-455-7223
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-0237
Mailing Address - Country:US
Mailing Address - Phone:570-455-7223
Mailing Address - Fax:570-455-7672
Practice Address - Street 1:465 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6711
Practice Address - Country:US
Practice Address - Phone:570-455-7223
Practice Address - Fax:570-455-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8000001532332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5219290001Medicare NSC