| Centerville Clinics Inc | |
|
Centerville Clinics-donora Family Medicine 718 Mckean Avenue Donora PA 15033-1061 | |
| (724) 379-4401 | |
| Not Available |
| Full Name | Centerville Clinics Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | Centerville Clinics-donora Family Medicine, Donora, Pennsylvania |
| Authorized Official Name and Position | Barry R Niccolai (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7246326801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerville Clinics Inc Centerville Clinics Inc 1070 Old National Pike Road Fredericktown PA 15333-2114 Ph: (724) 632-6801 | Centerville Clinics Inc Centerville Clinics-donora Family Medicine 718 Mckean Avenue Donora PA 15033-1061 Ph: (724) 379-4401 |
| NPI Number | 1164064002 |
|---|---|
| Provider Enumeration Date | 10/11/2019 |
| Last Update Date | 10/11/2019 |
| Medicare PECOS PAC ID | 7214837202 |
|---|---|
| Medicare Enrollment ID | O20210217003122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164064002 | NPI | - | NPPES |
| 1007288440027 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |