Provider Demographics
NPI:1639273816
Name:ATWOOD AND CLARK CONSULTANTS
Entity Type:Organization
Organization Name:ATWOOD AND CLARK CONSULTANTS
Other - Org Name:MIDWAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ATA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-658-9477
Mailing Address - Street 1:1630 D MIDLAND BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:INDUSTRY
Mailing Address - State:PA
Mailing Address - Zip Code:15052
Mailing Address - Country:US
Mailing Address - Phone:724-643-4101
Mailing Address - Fax:724-643-4102
Practice Address - Street 1:1630 D MIDLAND BEAVER RD
Practice Address - Street 2:
Practice Address - City:INDUSTRY
Practice Address - State:PA
Practice Address - Zip Code:15052
Practice Address - Country:US
Practice Address - Phone:724-643-4101
Practice Address - Fax:724-643-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011188300002Medicaid
PA1543350Medicaid
PA080611Medicare PIN
B43071Medicare UPIN
F00644Medicare UPIN
E74206Medicare UPIN