Provider Demographics
NPI:1902229883
Name:OLEAN MEDICAL GROUP PARTNERSHIP
Entity Type:Organization
Organization Name:OLEAN MEDICAL GROUP PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-372-0141
Mailing Address - Street 1:28 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1324
Mailing Address - Country:US
Mailing Address - Phone:814-642-0117
Mailing Address - Fax:814-642-0121
Practice Address - Street 1:28 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1324
Practice Address - Country:US
Practice Address - Phone:814-642-0117
Practice Address - Fax:814-642-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty