Organization
CENTERVILLE CLINICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY R NICCOLAI (EXECUTIVE DIRECTOR)
(724) 632-6801
Entity
Organization
Contact information
Practice address
CENTERVILLE CLINICS-DONORA FAMILY MEDICINE, 718 MCKEAN AVENUE, DONORA, PA 15033-1061
(724) 379-4401
Mailing address
CENTERVILLE CLINICS INC, 1070 OLD NATIONAL PIKE ROAD, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440027
—
PA
Enumeration date
10/11/2019
Last updated
10/11/2019
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