Provider Demographics
NPI:1063456531
Name:CLEARFIELD HOSPITAL
Entity Type:Organization
Organization Name:CLEARFIELD HOSPITAL
Other - Org Name:EMERGENCY ROOM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIOCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-768-2497
Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:P.O. BOX 992
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-765-5341
Mailing Address - Fax:814-768-2344
Practice Address - Street 1:809 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1232
Practice Address - Country:US
Practice Address - Phone:814-765-5341
Practice Address - Fax:814-768-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291301207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002684486OtherHIGHMARK BCBS ASSIGNMENT ACCOUNT
PA390052Medicare Oscar/Certification
PA002684486OtherHIGHMARK BCBS ASSIGNMENT ACCOUNT
PA000400673Medicare ID - Type UnspecifiedHM ID, MEDICARE PIN-E/D