Organization
CENTERVILLE CLINICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTY MARTOS (DIRECTOR PERSONEL FINANCE)
(724) 632-6801
Entity
Organization
Contact information
Practice address
1006 MAIN STREET,, REPUBLIC, PA 15475
(724) 246-9434
(724) 246-9846
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6801
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440032
—
PA
Enumeration date
04/27/2007
Last updated
07/22/2010
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