Provider Demographics
NPI:1235204611
Name:CLEARFIELD JEFFERSON HEAD AND NECK SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CLEARFIELD JEFFERSON HEAD AND NECK SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROSCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:814-375-0455
Mailing Address - Street 1:871 BEAVER DR
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2511
Mailing Address - Country:US
Mailing Address - Phone:814-375-0455
Mailing Address - Fax:814-375-2721
Practice Address - Street 1:871 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2511
Practice Address - Country:US
Practice Address - Phone:814-375-0455
Practice Address - Fax:814-375-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038440L207Y00000X
PAAT006006231H00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007698100009Medicaid
PA2036569OtherHIGHMARK BLUE SHIELD
PA2038288OtherHIGHMARK BLUE SHIELD
PA219994OtherHEALTHAMERICA/HEALTHASSURANCE
PACL4582OtherRAILROAD MEDICARE PIN
PA3489OtherGEISINGER HEALTH PLAN
PA2031692OtherHIGHMARK BLUE SHIELD
PA2031692OtherHIGHMARK BLUE SHIELD