| Centre Professional Associates Llc | |
|
315 S Allen St Ste 216 State College PA 16801-4849 | |
| (814) 689-9744 | |
| (888) 981-8069 |
| Full Name | Centre Professional Associates Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 315 S Allen St, State College, Pennsylvania |
| Authorized Official Name and Position | Timothy Derstine (OWNER) |
| Authorized Official Contact | 8146899744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centre Professional Associates Llc Po Box 1120 Lemont PA 16851-1120 Ph: (814) 689-9744 | Centre Professional Associates Llc 315 S Allen St Ste 216 State College PA 16801-4849 Ph: (814) 689-9744 |
| NPI Number | 1689025389 |
|---|---|
| Provider Enumeration Date | 06/24/2016 |
| Last Update Date | 06/24/2016 |
| Medicare PECOS PAC ID | 2961797642 |
|---|---|
| Medicare Enrollment ID | O20160819000157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689025389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | MD056013L (Pennsylvania) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD056013L (Pennsylvania) | Primary |
| Provider Name | Timothy H Derstine |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629076534 PECOS PAC ID: 2466355813 Enrollment ID: I20100819000458 |
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