| Keystone Rural Health Consortia Inc | |
|
402 East Sycamore Street Snow Shoe PA 16874-0402 | |
| (814) 387-6857 | |
| (814) 387-6870 |
| Full Name | Keystone Rural Health Consortia Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 402 East Sycamore Street, Snow Shoe, Pennsylvania |
| Authorized Official Name and Position | Ronald G Hammersley (CEO/ADMINISTRATOR) |
| Authorized Official Contact | 8144861115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Keystone Rural Health Consortia Inc 90 East Second Street Emporium PA 15834-1302 Ph: (814) 486-1115 | Keystone Rural Health Consortia Inc 402 East Sycamore Street Snow Shoe PA 16874-0402 Ph: (814) 387-6857 |
| NPI Number | 1174615686 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 01/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174615686 | NPI | - | NPPES |
| 1007763960018 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |