# GROVE CITY MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GCMC Pain Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609390483
- **Authorized official:** MR. ROBERT C JACKSON JR. (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (724) 450-7197

## Contact information

- **Practice address:** 631 N BROAD STREET EXT, GROVE CITY, PA 16127-4603
- **Practice address phone:** (724) 450-7000
- **Practice address fax:** (724) 450-7013
- **Mailing address:** 631 N. BROAD STREET EXT., GROVE CITY, PA 16127-4603
- **Mailing address phone:** (724) 450-7000
- **Mailing address fax:** (724) 450-7013

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | OS005324L | PA | Yes |
| 208VP0000X | Pain Medicine Physician | OS005324L | PA | — |

## Other

- **Enumeration date:** 08/02/2017
- **Last updated:** 08/02/2017