Organization
CENTERVILLE CLINICS, INC BENTWORTH SCHOOLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA MARTOS (DIRECTOR FINANCE AND PERSONNEL)
(724) 632-6801
Entity
Organization
Contact information
Practice address
75 BEARCAT DR, BENTLEYVILLE, PA 15314-1421
(724) 239-5911
(724) 239-4010
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
422450
CERTIFICATE OF COMPLIANCE
PA
05
—
APPLYING
—
PA
Enumeration date
02/04/2008
Last updated
02/04/2008
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