| Angelray Family Medical Llc | |
|
215 W Centre St Mahanoy City PA 17948-2505 | |
| (570) 590-2573 | |
| Not Available |
| Full Name | Angelray Family Medical Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 215 W Centre St, Mahanoy City, Pennsylvania |
| Authorized Official Name and Position | Kristin Marie O'donnell (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 5705902573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Angelray Family Medical Llc 215 W Centre St Mahanoy City PA 17948-2505 Ph: () - | Angelray Family Medical Llc 215 W Centre St Mahanoy City PA 17948-2505 Ph: (570) 590-2573 |
| NPI Number | 1952681074 |
|---|---|
| Provider Enumeration Date | 08/19/2011 |
| Last Update Date | 08/19/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952681074 | NPI | - | NPPES |
| 1021574590001 | Medicaid | PA | |
| 1104094291 | Other | PA | INDIVIDUAL PROVIDER NPI |
| 11974651 | Other | PA | CAQH PROVIDER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | SP009671 (Pennsylvania) | Primary |
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