| |
120 Locust Ave Ext Mount Morris PA 15349-1355 | |
(724) 324-9001 | |
(724) 324-9005 |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 120 Locust Ave Ext, Mount Morris, Pennsylvania |
Authorized Official Name and Position | Robert Mtjoy (CEO) |
Authorized Official Contact | 7249433308 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
120 Locust Ave Ext Mount Morris PA 15349-1355 Ph: (724) 324-9001 | 120 Locust Ave Ext Mount Morris PA 15349-1355 Ph: (724) 324-9001 |
NPI Number | 1124379680 |
---|---|
Provider Enumeration Date | 09/25/2012 |
Last Update Date | 09/26/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124379680 | NPI | - | NPPES |
1007725570024 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |