Organization
CHILDREN'S COMMUNITY CARE
Active
Other names
Children's Community Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
LORI MARTINEZ (EXECUTIVE ADMINISTRATOR III)
(724) 933-1100
Entity
Organization
Contact information
Practice address
56 CLUB LN, BLAIRSVILLE, PA 15717-7957
(724) 459-6560
Mailing address
103 BRADFORD RD STE 200, WEXFORD, PA 15090-6910
(724) 933-1100
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001597376
HIGHMARK ID#
PA
Enumeration date
08/03/2006
Last updated
09/13/2023
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