Organization
CLEARBROOK FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON E HENNINGER D.O. (OWNER/PHYSICIAN)
(814) 684-1245
Entity
Organization
Contact information
Practice address
863 S LINCOLN AVE, TYRONE, PA 16686-1349
(814) 684-1245
(814) 684-1246
Mailing address
863 S LINCOLN AVE, TYRONE, PA 16686-1349
(814) 684-1245
(814) 684-1246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS009583L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1496395
HIGHMARK BLUE CROSS
PA
01
—
204685
UPMC
PA
01
—
265732
HEALTH AMERICA
PA
01
—
42600
GEISINGER
PA
01
—
DB3021
RAILROAD MEDICARE
PA
Enumeration date
08/21/2006
Last updated
10/13/2010
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