Provider Demographics
NPI:1942430814
Name:CLEAR MED PROVIDER CORPORATION
Entity Type:Organization
Organization Name:CLEAR MED PROVIDER CORPORATION
Other - Org Name:CLEAR MED CARDIOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR, CLEAR MED
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-768-2356
Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2356
Mailing Address - Fax:814-768-2134
Practice Address - Street 1:531 HANNAH ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1209
Practice Address - Country:US
Practice Address - Phone:814-765-5159
Practice Address - Fax:814-765-6453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEARFIELD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-24
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430853207RC0000X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2158582OtherHIGHMARK BCBS ASSIGNMENT ACCOUNT
PA044540Medicare PIN