Provider Demographics
NPI:1871639138
Name:RAINONE GENERAL SURGERY PC
Entity Type:Organization
Organization Name:RAINONE GENERAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYLOU
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-621-5740
Mailing Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Mailing Address - Street 2:SUITE 204
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3663
Mailing Address - Country:US
Mailing Address - Phone:570-621-5740
Mailing Address - Fax:570-621-6367
Practice Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3663
Practice Address - Country:US
Practice Address - Phone:570-621-5740
Practice Address - Fax:570-621-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG3604OtherRAILROAD MEDICARE
886060OtherHIGHMARK BS
PA116429Medicare PIN