Provider Demographics
NPI:1184675035
Name:CLAYSVILLE FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:CLAYSVILLE FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-663-7731
Mailing Address - Street 1:1263 ROUTE 40 W
Mailing Address - Street 2:PO BOX N
Mailing Address - City:CLAYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15323-1277
Mailing Address - Country:US
Mailing Address - Phone:724-663-9018
Mailing Address - Fax:724-663-9022
Practice Address - Street 1:1263 ROUTE 40 W
Practice Address - Street 2:
Practice Address - City:CLAYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15323-1277
Practice Address - Country:US
Practice Address - Phone:724-663-9018
Practice Address - Fax:724-663-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty