Organization
WOLF CREEK MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANNE L BLAKE (PRACTICE ADMINISTRATOR)
(724) 450-7004
Entity
Organization
Contact information
Practice address
647 N BROAD STREET EXT, WOLF CREEK MEDICAL ASSOCIATES, GROVE CITY, PA 16127-4604
(724) 450-7004
(724) 450-7013
Mailing address
647 N BROAD STREET EXT, WOLF CREEK MEDICAL ASSOCIATES, GROVE CITY, PA 16127-4604
(724) 450-7004
(724) 450-7013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
PA
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
PA
208600000X
Surgery Physician
Primary
—
PA
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001960970
—
PA
Enumeration date
05/31/2005
Last updated
07/21/2022
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