Provider Demographics
NPI:1225047335
Name:CRAWFORD COUNTY SUB-SPECIALISTS GROUP
Entity Type:Organization
Organization Name:CRAWFORD COUNTY SUB-SPECIALISTS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIGBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-724-1252
Mailing Address - Street 1:640 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2348
Mailing Address - Country:US
Mailing Address - Phone:814-724-1252
Mailing Address - Fax:814-333-8871
Practice Address - Street 1:640 ALDEN ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2348
Practice Address - Country:US
Practice Address - Phone:814-724-1252
Practice Address - Fax:814-333-8871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEADVILLE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-07
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1885718OtherHIGHMAK
PA1017086210001Medicaid
PA1017086210001Medicaid