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99 Autumn St Suite 101 Aliquippa PA 15001-1301 | |
| (724) 375-3100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 99 Autumn St, Aliquippa, Pennsylvania |
| Authorized Official Name and Position | Norman Mitry (PRESIDENT & CEO) |
| Authorized Official Contact | 7247734776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
99 Autumn St Suite 101 Aliquippa PA 15001-1301 Ph: (724) 375-3100 | 99 Autumn St Suite 101 Aliquippa PA 15001-1301 Ph: (724) 375-3100 |
| NPI Number | 1275785057 |
|---|---|
| Provider Enumeration Date | 10/13/2008 |
| Last Update Date | 10/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275785057 | NPI | - | NPPES |
| 0015654460023 | Medicaid | PA | |
| 0202677 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
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