Organization Name: | CENTERVILLE CLINICS, INC. |
NPI Number: | 1043430267 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATTY MARTOS (DIRECTOR PERSONEL FINANCE) |
Mailing Address: | 1006 Main Street, Republic |
State: | PA US |
Postal Code: | 15475 |
Phone Number: | 7242469434 |
Fax Number: | 7242469846 |
NPI Enumeration Date: | 04/27/2007 |
NPI Last Update Date: | 07/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |