Basic Information
| Provider Information | |||||||||
| NPI: | 1124241542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | DELL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178223676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 02/01/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2014-01238 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD449522 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | D0066108 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 2086S0102X | D0066108 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | D66108 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 207RC0200X | MD449522 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002998792 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 415167400 | 05 | MD | MEDICAID | 1124241542 | 05 | NC | MEDICAID | 187MX | 01 | NC | BCBS NC | OTHER | 420288 | 01 | PA | UPMC | OTHER | 102848449 | 05 | PA | MEDICAID | 1623104 | 01 | PA | GATEWAY | OTHER | P00784514 | 01 | MD | RAILROAD MEDICARE | OTHER |