Provider Demographics
NPI:1730100900
Name:JOHNSTOWN CARDIOVASCULAR ASSOCIATES INC
Entity Type:Organization
Organization Name:JOHNSTOWN CARDIOVASCULAR ASSOCIATES INC
Other - Org Name:JOHNSTOWN CARDIOVASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:FOREBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-539-5340
Mailing Address - Street 1:1123 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4309
Mailing Address - Country:US
Mailing Address - Phone:814-539-5340
Mailing Address - Fax:814-536-1648
Practice Address - Street 1:1123 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4309
Practice Address - Country:US
Practice Address - Phone:814-539-5340
Practice Address - Fax:814-536-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty