=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194197467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RED HILL MEDICAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2015
-----------------------------------------------------
Last Update Date | 10/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7137 OLD EASTON RD SUITE 101
-----------------------------------------------------
City | PIPERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18947-9708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-766-1300
-----------------------------------------------------
Fax | 215-766-1321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7137 OLD EASTON RD SUITE 101
-----------------------------------------------------
City | PIPERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18947-9708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KRISTANN HEINZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 215-766-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD442653
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------