Provider Demographics
NPI:1205986296
Name:PHILIP A GELACEK MD PC
Entity type:Organization
Organization Name:PHILIP A GELACEK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:GELACEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-763-7144
Mailing Address - Street 1:904 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1212
Mailing Address - Country:US
Mailing Address - Phone:724-763-7144
Mailing Address - Fax:724-763-7161
Practice Address - Street 1:904 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1212
Practice Address - Country:US
Practice Address - Phone:724-763-7144
Practice Address - Fax:724-763-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020788E207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA127047Medicare ID - Type Unspecified
PAB31213Medicare UPIN