Provider Demographics
NPI:1316039928
Name:ATWOOD & CLARK CONSULTANTS
Entity Type:Organization
Organization Name:ATWOOD & CLARK CONSULTANTS
Other - Org Name:MIDWAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ATA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULHAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-658-9477
Mailing Address - Street 1:3548 ELLWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101
Mailing Address - Country:US
Mailing Address - Phone:724-658-9477
Mailing Address - Fax:724-658-9476
Practice Address - Street 1:3548 ELLWOOD ROAD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101
Practice Address - Country:US
Practice Address - Phone:724-658-9477
Practice Address - Fax:724-658-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011350060008Medicaid
PA1011188300002Medicaid
PA1849960019Medicaid
PA0012149600019Medicaid
PA1011188300001Medicaid
F00644Medicare UPIN
E74206Medicare UPIN
PA1849960019Medicaid
PA0011350060008Medicaid