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3205 S Main St Sandy Lake PA 16145 | |
(724) 376-7111 | |
(724) 376-7165 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3205 S Main St, Sandy Lake, Pennsylvania |
Authorized Official Name and Position | Carl A Sizer (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 7243420126 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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63 Pitt St Sharon PA 16146-2102 Ph: (724) 342-3002 | 3205 S Main St Sandy Lake PA 16145 Ph: (724) 376-7111 |
NPI Number | 1083084495 |
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Provider Enumeration Date | 09/28/2015 |
Last Update Date | 07/11/2024 |
Medicare PECOS PAC ID | 9234046228 |
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Medicare Enrollment ID | O20151124002875 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083084495 | NPI | - | NPPES |
1007578460118 | Medicaid | PA | |
0164904 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |