| Fairfield Ave Family Practice | |
|
226 Fairfield Ave Johnstown PA 15906-2310 | |
| (814) 535-6167 | |
| Not Available |
| Full Name | Fairfield Ave Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 226 Fairfield Ave, Johnstown, Pennsylvania |
| Authorized Official Name and Position | Carol Elizabeth Kowtoniuk (VICE PRESIDENT) |
| Authorized Official Contact | 8145356167 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairfield Ave Family Practice 226 Fairfield Ave Johnstown PA 15906-2310 Ph: (814) 535-6167 | Fairfield Ave Family Practice 226 Fairfield Ave Johnstown PA 15906-2310 Ph: (814) 535-6167 |
| NPI Number | 1114130929 |
|---|---|
| Provider Enumeration Date | 05/08/2007 |
| Last Update Date | 03/03/2016 |
| Medicare PECOS PAC ID | 5597703579 |
|---|---|
| Medicare Enrollment ID | O20050420000715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114130929 | NPI | - | NPPES |
| 1007300380005 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Walter V Kowtoniuk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972643336 PECOS PAC ID: 5294911004 Enrollment ID: I20110513000588 |
| Provider Name | Carol E Kowtoniuk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144369869 PECOS PAC ID: 6103002910 Enrollment ID: I20110602000666 |
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