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45 N Pine St Port Allegany PA 16743-1238 | |
(814) 642-9655 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 45 N Pine St, Port Allegany, Pennsylvania |
Authorized Official Name and Position | Ron S Rapp (CFO) |
Authorized Official Contact | 8142605250 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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45 N Pine St Port Allegany PA 16743-1238 Ph: (814) 642-9655 | 45 N Pine St Port Allegany PA 16743-1238 Ph: (814) 642-9655 |
NPI Number | 1760554265 |
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Provider Enumeration Date | 11/14/2006 |
Last Update Date | 06/09/2022 |
Medicare PECOS PAC ID | 3779487475 |
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Medicare Enrollment ID | O20080728000535 |
Identifier | Type | State | Issuer |
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1760554265 | NPI | - | NPPES |
100001127-0072 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Olean Medical Group Partnership Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 28 N Main St, Port Allegany, PA 16743 Phone: 814-642-0117 Fax: 814-642-0121 | |