Provider Demographics
NPI:1447247986
Name:EDGAR A BOONE JOY L BOONE MD
Entity type:Organization
Organization Name:EDGAR A BOONE JOY L BOONE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-446-5571
Mailing Address - Street 1:401 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HERMINIE
Mailing Address - State:PA
Mailing Address - Zip Code:15637-1457
Mailing Address - Country:US
Mailing Address - Phone:724-446-5571
Mailing Address - Fax:724-446-2151
Practice Address - Street 1:401 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HERMINIE
Practice Address - State:PA
Practice Address - Zip Code:15637-1457
Practice Address - Country:US
Practice Address - Phone:724-446-5571
Practice Address - Fax:724-446-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0473267OtherAETNA GROUP ID NUMBER
PA104152OtherUPMC ID NUMBER
PA1409575OtherUMWA ID NUMBER
PADG3332OtherRAILROAD MEDICARE
PA1003102OtherGATEWAY ID NUMBER
PA1409575OtherUMWA ID NUMBER