Provider Demographics
NPI:1013218270
Name:KEYSTONE RURAL HEALTH CENTER
Entity Type:Organization
Organization Name:KEYSTONE RURAL HEALTH CENTER
Other - Org Name:KEYSTONE INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDEN AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-709-7906
Mailing Address - Street 1:111 CHAMBERS HILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7304
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:755 NORLAND AVE.
Practice Address - Street 2:SUITE 207
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4223
Practice Address - Country:US
Practice Address - Phone:717-217-6804
Practice Address - Fax:717-217-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)