Provider Demographics
NPI:1578043592
Name:MGF ENTERPRISES PC
Entity Type:Organization
Organization Name:MGF ENTERPRISES PC
Other - Org Name:GREATER PITTSTON UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPENNI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-760-1901
Mailing Address - Street 1:250 KENNEDY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1814
Mailing Address - Country:US
Mailing Address - Phone:570-760-1901
Mailing Address - Fax:
Practice Address - Street 1:250 KENNEDY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1814
Practice Address - Country:US
Practice Address - Phone:570-760-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208800000X
PAOS008694L261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty