| Centre Geriatric Care, LLC | |
|
2134 Sandy Dr Ste 16 State College PA 16803-2292 | |
| (814) 272-5805 | |
| (814) 272-0110 |
| Full Name | Centre Geriatric Care, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 2134 Sandy Dr Ste 16, State College, Pennsylvania |
| Authorized Official Name and Position | Eileen Clarke (PRACTICE MANAGER) |
| Authorized Official Contact | 8143596866 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centre Geriatric Care, LLC 2134 Sandy Dr Ste 16 State College PA 16803-2292 Ph: (814) 272-5805 | Centre Geriatric Care, LLC 2134 Sandy Dr Ste 16 State College PA 16803-2292 Ph: (814) 272-5805 |
| NPI Number | 1962166611 |
|---|---|
| Provider Enumeration Date | 10/28/2021 |
| Last Update Date | 03/22/2022 |
| Certification Date | 03/22/2022 |
| Medicare PECOS PAC ID | 1355731670 |
|---|---|
| Medicare Enrollment ID | O20211201000094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962166611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Dennis A. Shannon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770546434 PECOS PAC ID: 6204963341 Enrollment ID: I20100422000272 |
| Provider Name | Xenia I Kugler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740843531 PECOS PAC ID: 0648501759 Enrollment ID: I20191003001787 |
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