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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