Organization
FAMILY HEALTH CARE CENTER OF PUNXSUTAWNEY, INC.
Active
Organization
FAMILY HEALTH CARE CENTER OF PUNXSUTAWNEY, INC.
Active
Other names
Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP JOHN STATES M.D. (OWNER/PROPRIETOR)
(814) 938-3550
Entity
Organization
Contact information
Practice address
83 HILLCREST DR, SUITE 200, PUNXSUTAWNEY, PA 15767-2605
(814) 938-3550
(814) 938-3679
Mailing address
83 HILLCREST DR, SUITE 200, PUNXSUTAWNEY, PA 15767-2605
(814) 938-3550
(814) 938-3679
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
393918
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019257860003
—
PA
01
—
393918
RHC CCN
—
Enumeration date
01/06/2012
Last updated
04/28/2015
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