Provider Demographics
| NPI: | 1033252879 |
|---|---|
| Name: | BLAIR MEDICAL ASSOCIATES |
| Entity Type: | Organization |
| Organization Name: | BLAIR MEDICAL ASSOCIATES |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PROJECTS MGR. |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JENNIFER |
| Authorized Official - Middle Name: | L |
| Authorized Official - Last Name: | BRYAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 814-949-7621 |
| Mailing Address - Street 1: | 1414 9TH AVE |
| Mailing Address - Street 2: | STATION MEDICAL CENTER |
| Mailing Address - City: | ALTOONA |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 16602-2415 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 814-949-7621 |
| Mailing Address - Fax: | 814-949-7616 |
| Practice Address - Street 1: | 1414 9TH AVE |
| Practice Address - Street 2: | STATION MEDICAL CENTER |
| Practice Address - City: | ALTOONA |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 16602-2415 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 814-949-7621 |
| Practice Address - Fax: | 814-949-7616 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-02-14 |
| Last Update Date: | 2008-04-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 1015349 | Other | GATEWAY FP NUMBER |
| PA | 1015438 | Other | GATEWAY SURG. NUMBER |
| PA | 1015584 | Other | GATEWAY DERM NUMBER |
| PA | 1007393100001 | Medicaid | |
| PA | 1007393100021 | Other | ALTOONA MA GROUP NUMBER (OLD-UNION AVE OFFICE) |
| PA | 1015582 | Other | GATEWAY ENDO NUMBER |
| PA | 0015864460004 | Other | MA NUMBER FOR DR. SCHLECHTER ALTOONA OFFICE |
| PA | 1015429 | Other | GATEWAY PODIATRY NUMBER |
| PA | 1556762 | Other | GATEWAY OB GYN NUMBER |
| PA | 0011895710004 | Other | PEDIATRICS GROUP MA NUMBER |
| PA | 1007393100101 | Medicaid | |
| PA | 0008222080014 | Other | DR. MANIGLIA'S MA PROVIDER NUMBER (18TH ST. OLD OFFICE) |
| PA | 0011392930016 | Other | DR. MEXTORF MA NUMBER FOR ALTOONA |
| PA | 1007393100018 | Medicaid | |
| PA | 1014409 | Other | GATEWAY NEUROLOGY NUMBER |
| PA | 1019546 | Other | GATEWAY PEDS NUMBER |
| PA | 0014787610002 | Medicaid | |
| PA | 10073931000102 | Medicaid | |
| PA | 1015340 | Other | GATEWAY IM NUMBER |
| PA | 1007393100022 | Medicaid | |
| PA | 0014172930011 | Other | DR. FLORES' MA NUMBER FOR ALTOONA |
