Provider Demographics
NPI:1265779649
Name:KRISTY D. FOX
Entity type:Organization
Organization Name:KRISTY D. FOX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:CH, CLC, RM
Authorized Official - Phone:724-498-4276
Mailing Address - Street 1:16 ROONEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2453
Mailing Address - Country:US
Mailing Address - Phone:724-498-4276
Mailing Address - Fax:724-498-4876
Practice Address - Street 1:824 MERCER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-8416
Practice Address - Country:US
Practice Address - Phone:724-498-4276
Practice Address - Fax:724-498-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center