Organization
CENTERVILLE CLINICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY R NICCOLAI (CEO)
(412) 582-1586
Entity
Organization
Contact information
Practice address
100 WILSON RD, BENTLEYVILLE, PA 15314-1028
(724) 239-2390
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
—
1007288440030
—
PA
Enumeration date
04/11/2007
Last updated
02/05/2026
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