Provider Demographics
NPI:1841254547
Name:HUGHESTOWN HEALTH SERVICES, PC
Entity type:Organization
Organization Name:HUGHESTOWN HEALTH SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHIAVACCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-388-2923
Mailing Address - Street 1:2352 NEWTON RANSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9650
Mailing Address - Country:US
Mailing Address - Phone:570-388-2612
Mailing Address - Fax:570-388-0946
Practice Address - Street 1:2352 NEWTON RANSOM BLVD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9650
Practice Address - Country:US
Practice Address - Phone:570-388-2612
Practice Address - Fax:570-388-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039389L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011539170011Medicaid
0072770000OtherINDEPENDENCE BLUE CROSS
124627OtherHEALTH ASSURANCE
HU1596910OtherHIGHMARK BLUE SHIELD
PA077237/032459SKMMedicare ID - Type UnspecifiedMEDICARE
HU1596910OtherHIGHMARK BLUE SHIELD