Healthcare Provider Details

I. General information

NPI: 1225027287
Provider Name (Legal Business Name): MRS. JANET C WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 WASHINGTON RD
MC MURRAY PA
15317-2543
US

IV. Provider business mailing address

4050 WASHINGTON RD
MC MURRAY PA
15317-2543
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-0705
  • Fax: 724-942-4726
Mailing address:
  • Phone: 724-942-0705
  • Fax: 724-942-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0079082
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerU S HEALTHCARE
# 2
Identifier212870
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC HEALTHPLAN
# 3
Identifier79082
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA
# 4
Identifier16431
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTHAMERICA
# 5
Identifier0018241270002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 6
IdentifierB20318
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH
# 7
Identifier220318
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: