Provider Demographics
NPI:1063670479
Name:CLEAR MED PROVIDER CORPORATION
Entity Type:Organization
Organization Name:CLEAR MED PROVIDER CORPORATION
Other - Org Name:CLEAR MED BRIGHT HORIZONS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR CLEAR MED
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-768-2356
Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2356
Mailing Address - Fax:814-768-2134
Practice Address - Street 1:1033 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3061
Practice Address - Country:US
Practice Address - Phone:814-768-2137
Practice Address - Fax:814-768-2084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARFIELD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-02
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 261QM0801X
PACW000309L1041C0700X
PACW0152811041C0700X
PASW013007L1041C0700X
PAMA051098363A00000X
PASP010448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2502939OtherCLEAR MED PROVIDER CORPORATION HIGHMARK ASSIGNMENT ACCOUNT
PA1656848OtherHIGHMARK ASSIGNMENT ACCOUNT
PA1656848OtherHIGHMARK ASSIGNMENT ACCOUNT