Provider Demographics
NPI:1831466937
Name:CONEMAUGH HEALTH INITIATIVES
Entity Type:Organization
Organization Name:CONEMAUGH HEALTH INITIATIVES
Other - Org Name:CONEMAUGH PHYSICIAN GROUP- FAMILY MEDICINE- JENNERSTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-534-1678
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-534-1643
Mailing Address - Fax:814-534-1396
Practice Address - Street 1:1611 W. PITT STREET
Practice Address - Street 2:
Practice Address - City:JENNERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15547-0190
Practice Address - Country:US
Practice Address - Phone:814-629-5647
Practice Address - Fax:814-629-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009654520002Medicaid
PA0009654520002Medicaid