Provider Demographics
NPI:1356495477
Name:MEADVILLE MEDICAL CENTER
Entity Type:Organization
Organization Name:MEADVILLE MEDICAL CENTER
Other - Org Name:CARDIOLOGY FPA
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUNTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-333-5031
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5000
Mailing Address - Fax:814-333-5640
Practice Address - Street 1:751 LIBERTY ST
Practice Address - Street 2:CARDIOLOGY FPA
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2559
Practice Address - Country:US
Practice Address - Phone:814-333-5155
Practice Address - Fax:814-333-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00033412OtherBLUE CROSS BLUE SHIELD
PA402340Medicare PIN