Organization
COMMUNITY HEALTH CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RAJI JAYAKRISHNAN (EXECUTIVE DIRECTOR)
(724) 335-3334
Entity
Organization
Contact information
Practice address
943 FOURTH AVENUE, NEW KENSINGTON, PA 15068-6409
(724) 335-3334
(724) 335-2283
Mailing address
943 FOURTH AVENUE, NEW KENSINGTON, PA 15068-6409
(724) 335-3334
(724) 335-2283
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DS019493L
PA
261Q00000X
Clinic/Center
MD035908L
PA
261Q00000X
Clinic/Center
Primary
MD440474
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001696755
BC/BS GROUP NUMBER
PA
05
—
1012676430003
—
PA
01
—
1546540
GATEWAY HEALTH PLAN
PA
01
—
3976949
AETNAUS HEALTHCARE GROUP#
PA
Enumeration date
06/25/2006
Last updated
06/02/2016
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