Provider Demographics
NPI:1508016155
Name:PUNXSUTAWNEY MEDICAL SERVICES UROLOGY
Entity Type:Organization
Organization Name:PUNXSUTAWNEY MEDICAL SERVICES UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:UBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-938-1451
Mailing Address - Street 1:81 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-1451
Mailing Address - Fax:814-938-1453
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-1451
Practice Address - Fax:814-938-1453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUNXSUTAWNEY MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431940208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty