Provider Demographics
NPI:1417912692
Name:CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Other - Org Name:DEPARTMENT OF PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:COO/ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCQUEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-234-4753
Mailing Address - Street 1:3901 S ATHERTON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-8324
Mailing Address - Country:US
Mailing Address - Phone:814-466-7921
Mailing Address - Fax:814-466-6570
Practice Address - Street 1:3901 S ATHERTON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-466-7921
Practice Address - Fax:814-466-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017801E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA713537OtherHIGHMARK BLUE SHIELD