Provider Demographics
NPI:1619149796
Name:ONDICH RURAL HEALTH CENTER
Entity Type:Organization
Organization Name:ONDICH RURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ONDICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-783-7124
Mailing Address - Street 1:10261 STATE ROUTE 85
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8165
Mailing Address - Country:US
Mailing Address - Phone:724-783-7124
Mailing Address - Fax:724-783-7999
Practice Address - Street 1:10261 STATE ROUTE 85
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8165
Practice Address - Country:US
Practice Address - Phone:724-783-7124
Practice Address - Fax:724-783-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006237L261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
13484OtherUNITED MINE WORKERS
000322671OtherBLUE SHIELD
1010616OtherGATEWAY
203221OtherUPMC
PA1007508360006Medicaid
480354OtherAETNA
000322671OtherBLUE SHIELD
PA393834Medicare Oscar/Certification