Provider Demographics
NPI:1811047012
Name:JOSE R. ACOSTA, M.D., P.C.
Entity type:Organization
Organization Name:JOSE R. ACOSTA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:STAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-242-2711
Mailing Address - Street 1:27 SANDY LN
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1310
Mailing Address - Country:US
Mailing Address - Phone:717-242-2711
Mailing Address - Fax:717-248-0502
Practice Address - Street 1:27 SANDY LN
Practice Address - Street 2:SUITE 140
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1310
Practice Address - Country:US
Practice Address - Phone:717-242-2711
Practice Address - Fax:717-248-0502
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 Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02552500OtherCAPITAL BLUE CROSS
PA076706OtherPENNSYLVANIA BLUE SHIELD
PA0009520150004Medicaid
PAC30466Medicare UPIN
PA0009520150004Medicaid