Organization
CENTERVILLE CLINICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY R NICCOLAI (EXECUTIVE DIRECTOR)
(724) 632-6801
Entity
Organization
Contact information
Practice address
601 SOUTH ARCH STREET, CONNELLSVILLE, PA 15425
(724) 626-2630
(724) 626-2655
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440037
—
PA
01
—
391911
NATIONAL GOVERNMENT SERVICES
PA
Enumeration date
04/10/2007
Last updated
12/02/2020
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