Provider Demographics
NPI:1043865140
Name:JC BLAIR MEDICAL SERVICES INC CARDIAC CARE CENTER
Entity Type:Organization
Organization Name:JC BLAIR MEDICAL SERVICES INC CARDIAC CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:HETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-643-8295
Mailing Address - Street 1:1225 WARM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2350
Mailing Address - Country:US
Mailing Address - Phone:814-643-8478
Mailing Address - Fax:814-643-7043
Practice Address - Street 1:1227 WARM SPRINGS AVE FL 2
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2300
Practice Address - Country:US
Practice Address - Phone:814-643-8478
Practice Address - Fax:814-643-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty