Provider Demographics
| NPI: | 1184605438 |
|---|---|
| Name: | CENTERVILLE CLINICS INC |
| Entity type: | Organization |
| Organization Name: | CENTERVILLE CLINICS INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF FINANCE/PERSONNEL |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | PATRICIA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MARTOS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 724-632-6801 |
| Mailing Address - Street 1: | 1070 OLD NATIONAL PIKE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FREDERICKTOWN |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 15333-2114 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 724-632-6801 |
| Mailing Address - Fax: | 724-632-6312 |
| Practice Address - Street 1: | 1070 OLD NATIONAL PIKE |
| Practice Address - Street 2: | |
| Practice Address - City: | FREDERICKTOWN |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 15333-2114 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 724-632-6801 |
| Practice Address - Fax: | 724-632-6312 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-11-11 |
| Last Update Date: | 2008-01-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207KA0200X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | Group - Multi-Specialty |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 124Q00000X | Dental Providers | Dental Hygienist | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 032094 | Other | HGSA MEDICARE |
| PA | 031218 | Other | HGSA MEDICARE |
| PA | 030163 | Other | HGSA MEDICARE |
| PA | 031216 | Other | HGSA MEDICARE |
| PA | 031395 | Other | HGSA MEDICARE |
| PA | 1007288440027 | Medicaid | |
| PA | 031221 | Other | HGSA MEDICARE |
| PA | 032095 | Other | HGSA MEDICARE |
| PA | 026902 | Other | HGSA MEDICARE |
| PA | 026902 | Other | HGSA MEDICARE |
| PA | 031216 | Other | HGSA MEDICARE |
