Provider Demographics
NPI:1609005651
Name:SO.HUNTINGDONCO.SERVICECOMMITTEE,INC.
Entity Type:Organization
Organization Name:SO.HUNTINGDONCO.SERVICECOMMITTEE,INC.
Other - Org Name:SO.HUNTINGDONCO.MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C,MPAS
Authorized Official - Phone:814-447-5556
Mailing Address - Street 1:626 WATER ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ORBISONIA
Mailing Address - State:PA
Mailing Address - Zip Code:17243-9432
Mailing Address - Country:US
Mailing Address - Phone:814-447-5556
Mailing Address - Fax:814-447-5682
Practice Address - Street 1:626 WATER ST
Practice Address - Street 2:SUITE #1
Practice Address - City:ORBISONIA
Practice Address - State:PA
Practice Address - Zip Code:17243-0040
Practice Address - Country:US
Practice Address - Phone:814-447-5556
Practice Address - Fax:814-447-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008434780002Medicaid