Provider Demographics
NPI:1629204060
Name:CLEAR MED PROVIDER GROUP
Entity Type:Organization
Organization Name:CLEAR MED PROVIDER GROUP
Other - Org Name:CLEAR MED MAHAFFEY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLEAR MED ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-768-2356
Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2356
Mailing Address - Fax:814-768-2134
Practice Address - Street 1:2772 CECIL HURD HWY
Practice Address - Street 2:
Practice Address - City:MAHAFFEY
Practice Address - State:PA
Practice Address - Zip Code:15757-6322
Practice Address - Country:US
Practice Address - Phone:814-277-4504
Practice Address - Fax:814-277-6873
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARFIELD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-29
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047546L207Q00000X
PAMD031136L207R00000X
261QH0100X
PAMA051554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0166056OtherHIGHMARK
PA001829615Medicaid
PA0166056OtherHIGHMARK