Provider Demographics
NPI:1649412941
Name:PRIMARY CARE CENTER OF MOUNT MORRIS
Entity Type:Organization
Organization Name:PRIMARY CARE CENTER OF MOUNT MORRIS
Other - Org Name:PRIMARY CARE CENTER OF MOUNT MORRIS - MOBILE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MT. JOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-324-9001
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349-0495
Mailing Address - Country:US
Mailing Address - Phone:724-324-9001
Mailing Address - Fax:724-324-9005
Practice Address - Street 1:104 FRONT STREET
Practice Address - Street 2:SUITE VAN 1
Practice Address - City:MOUNT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349-0495
Practice Address - Country:US
Practice Address - Phone:888-454-5064
Practice Address - Fax:724-324-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty