Provider Demographics
NPI:1144589953
Name:H.B.P.A. MEDICAL CLINIC
Entity Type:Organization
Organization Name:H.B.P.A. MEDICAL CLINIC
Other - Org Name:JEANETTE JOHNSTON H.B.P.A MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-469-2970
Mailing Address - Street 1:1111 FIREHOUSE RD.
Mailing Address - Street 2:
Mailing Address - City:GRANTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17028
Mailing Address - Country:US
Mailing Address - Phone:717-469-2970
Mailing Address - Fax:717-469-7714
Practice Address - Street 1:1111 FIRE HOUSE RD
Practice Address - Street 2:
Practice Address - City:GRANTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17028
Practice Address - Country:US
Practice Address - Phone:717-469-2970
Practice Address - Fax:717-469-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN163-298L163W00000X
PAOS-006156-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty