| |
25 Cree Dr Lock Haven PA 17745-2600 | |
(570) 893-5000 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Ambulatory Surgical |
Location | 25 Cree Dr, Lock Haven, Pennsylvania |
Authorized Official Name and Position | Gary Newsome (PRESIDENT GROUP OPERATIONS) |
Authorized Official Contact | 6154657000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 503847 Saint Louis MO 63150-0001 Ph: (570) 893-5000 | 25 Cree Dr Lock Haven PA 17745-2600 Ph: (570) 893-5000 |
NPI Number | 1851507123 |
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Provider Enumeration Date | 05/15/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851507123 | NPI | - | NPPES |
1007550910012 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 1222201 (Pennsylvania) | Primary |
261QA1903X | Clinic/center - Ambulatory Surgical | 122201 (Pennsylvania) | Primary |
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