Provider Demographics
NPI:1477785335
Name:FEDERAL BUREAU OF PRISONS/FCI LORETTO
Entity Type:Organization
Organization Name:FEDERAL BUREAU OF PRISONS/FCI LORETTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES PROGRAM ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-471-1421
Mailing Address - Street 1:772 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-7006
Mailing Address - Country:US
Mailing Address - Phone:814-471-1421
Mailing Address - Fax:814-471-1596
Practice Address - Street 1:772 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-7006
Practice Address - Country:US
Practice Address - Phone:814-471-1421
Practice Address - Fax:814-471-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health