| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 90 E 2nd St, Emporium, Pennsylvania |
| Authorized Official Name and Position | Kristie Bennardi (CEO) |
| Authorized Official Contact | 8144861115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 270 Emporium PA 15834-0270 Ph: (814) 486-1115 | 90 E 2nd St Emporium PA 15834-1302 Ph: (814) 486-1115 |
| NPI Number | 1215451927 |
|---|---|
| Provider Enumeration Date | 08/03/2017 |
| Last Update Date | 05/13/2024 |
| Medicare PECOS PAC ID | 8022055078 |
|---|---|
| Medicare Enrollment ID | O20240530000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215451927 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Cameron County Dental Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 90 E 2nd St, Emporium, PA 15834 Phone: 814-486-0909 Fax: 814-486-0404 | |
Charles A. Blumle D.d.s., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 N Maple St, Emporium, PA 15834 Phone: 814-486-0650 |