Provider Demographics
NPI:1801988670
Name:KEYSTONE RURAL HEALTH CONSORTIA, INC.
Entity type:Organization
Organization Name:KEYSTONE RURAL HEALTH CONSORTIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSCATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-486-1115
Mailing Address - Street 1:17129 ROUTE 6
Mailing Address - Street 2:P.O. BOX 457
Mailing Address - City:SMETHPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16749-4027
Mailing Address - Country:US
Mailing Address - Phone:814-887-5395
Mailing Address - Fax:814-887-5342
Practice Address - Street 1:17129 ROUTE 6
Practice Address - Street 2:
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749-4027
Practice Address - Country:US
Practice Address - Phone:814-887-5395
Practice Address - Fax:814-887-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391971Medicare Oscar/Certification