Provider Demographics
NPI:1871683573
Name:JOHN MITCHELL MD PC
Entity Type:Organization
Organization Name:JOHN MITCHELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-351-0625
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 502
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2355
Mailing Address - Country:US
Mailing Address - Phone:610-351-0625
Mailing Address - Fax:
Practice Address - Street 1:1605 N CEDAR CREST BLVD STE 502
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2355
Practice Address - Country:US
Practice Address - Phone:610-351-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213680261QM0801X
PA397040261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
1862OtherHIGHMARK BS
390766OtherCAPITAL BLUE CROSS
A926OtherAMERIHEALTH ADMIN
1881742377OtherCBC, HIGHMARK
2181265OtherCIGNA BEH HEALTH
476535OtherVALUE OPTIONS
014261OtherMANAGED HEALTH NETWORK
PA0014259640001Medicaid
102791000OtherMAGELLAN BEH HEALTH
A3159040OtherOXFORD HEALTH PLAN
0002391000OtherINDEPENDENCE BLUE CROSS
0008496118OtherAETNA
1861OtherHIGHMARK BS
0002391000OtherINDEPENDENCE BLUE CROSS