Provider Demographics
NPI:1881651016
Name:CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Other - Org Name:PEDIATRICS BELLEFONTE
Other - Org Type:Other Name
Authorized Official - Title/Position:COO/ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-234-4753
Mailing Address - Street 1:141 MEDICAL PARK LN
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-9112
Mailing Address - Country:US
Mailing Address - Phone:814-355-3626
Mailing Address - Fax:814-355-8479
Practice Address - Street 1:141 MEDICAL PARK LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9112
Practice Address - Country:US
Practice Address - Phone:814-355-3626
Practice Address - Fax:814-355-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019154E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007679310031Medicaid