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103 Forestview Ave Elkland PA 16920-1403 | |
(814) 258-5117 | |
(814) 258-5510 |
Full Name | |
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Speciality | Clinic/Center |
Location | 103 Forestview Ave, Elkland, Pennsylvania |
Authorized Official Name and Position | Angela M. Vanzile (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 5706621945 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6a Riverside Plz Blossburg PA 16912-1137 Ph: (570) 662-1945 | 103 Forestview Ave Elkland PA 16920-1403 Ph: (814) 258-5117 |
NPI Number | 1003913955 |
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Provider Enumeration Date | 09/20/2006 |
Last Update Date | 06/08/2022 |
Medicare PECOS PAC ID | 0446245880 |
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Medicare Enrollment ID | O20050517000575 |
Identifier | Type | State | Issuer |
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1003913955 | NPI | - | NPPES |
1000011720036 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |