Individual
MR. JOHN MARSHALL PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.PED
Contact information
Practice address
25 LAUREL MALL, PROVOST SHOES, HAZLETON, PA 18202-1201
(570) 455-7704
(570) 455-7704
Mailing address
732 NORTH ST, W HAZLETON, PA 18202-3615
(570) 455-7704
(570) 454-6324
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4244780002
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A08009797
MEDICARE EDI BILLING NUMB
PA
Enumeration date
03/21/2007
Last updated
07/08/2007
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us