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120 Locust Avenue Extension Mount Morris PA 15349 | |
(724) 324-9001 | |
(724) 324-9005 |
Full Name | |
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Speciality | Clinic/Center |
Location | 120 Locust Avenue Extension, Mount Morris, Pennsylvania |
Authorized Official Name and Position | Robert Mtjoy (CEO) |
Authorized Official Contact | 7249433308 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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120 Locust Avenue Extension Mount Morris PA 15349 Ph: (724) 324-9001 | 120 Locust Avenue Extension Mount Morris PA 15349 Ph: (724) 324-9001 |
NPI Number | 1194029819 |
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Provider Enumeration Date | 01/10/2011 |
Last Update Date | 08/16/2011 |
Medicare PECOS PAC ID | 7911811583 |
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Medicare Enrollment ID | O20111209000561 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194029819 | NPI | - | NPPES |
100772557-0024 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |