Provider Demographics
NPI:1558537308
Name:CRAWFORD COUNTY SUB-SPECIALISTS GROUP
Entity Type:Organization
Organization Name:CRAWFORD COUNTY SUB-SPECIALISTS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-333-5031
Mailing Address - Street 1:764 KENNEDY ST SUITE 303
Mailing Address - Street 2:INFECTIOUS DISEASE AND TRAVEL HEALTH OF MEADVILLE
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-373-2195
Mailing Address - Fax:814-333-2197
Practice Address - Street 1:764 KENNEDY ST SUITE 303
Practice Address - Street 2:INFECTIOUS DISEASE AND TRAVEL HEALTH OF MEADVILLE
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-373-2195
Practice Address - Fax:814-333-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106347Medicare PIN