Provider Demographics
NPI:1679194039
Name:MIFFLIN JUNIATA AAA, INC.
Entity Type:Organization
Organization Name:MIFFLIN JUNIATA AAA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:717-242-0315
Mailing Address - Street 1:249 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2004
Mailing Address - Country:US
Mailing Address - Phone:717-320-8290
Mailing Address - Fax:
Practice Address - Street 1:249 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2004
Practice Address - Country:US
Practice Address - Phone:717-320-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care