Provider Demographics
NPI:1194854463
Name:PUNXSUTAWNEY MEDICAL SERVICES - ENT
Entity Type:Organization
Organization Name:PUNXSUTAWNEY MEDICAL SERVICES - ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-938-1882
Mailing Address - Street 1:81 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-1450
Mailing Address - Fax:814-938-1885
Practice Address - Street 1:1464 N MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2609
Practice Address - Country:US
Practice Address - Phone:814-938-2300
Practice Address - Fax:814-938-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 067875L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty