Provider Demographics
NPI:1710951033
Name:ALTOONA SPECIALITY CENTER LLC
Entity Type:Organization
Organization Name:ALTOONA SPECIALITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-693-0300
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635
Mailing Address - Country:US
Mailing Address - Phone:814-693-0300
Mailing Address - Fax:814-693-0400
Practice Address - Street 1:1125 OLD ROUTE 220 NORTH
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-693-0300
Practice Address - Fax:814-693-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1864261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0399OtherPA BLUE SHIELD
091538Medicare ID - Type Unspecified
0399OtherPA BLUE SHIELD