Provider Demographics
NPI:1881740918
Name:MID STATE MEDICAL INC
Entity type:Organization
Organization Name:MID STATE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-342-7399
Mailing Address - Street 1:601 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-2303
Mailing Address - Country:US
Mailing Address - Phone:814-342-7399
Mailing Address - Fax:814-342-5470
Practice Address - Street 1:601 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2303
Practice Address - Country:US
Practice Address - Phone:814-342-7399
Practice Address - Fax:814-342-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014408560001Medicaid
PA1775451OtherBLUE SHIELD
PA03168000OtherCAPITOL BLUE CROSS
PA358539OtherCOVENTRY HEALTHCARE MANAG
PA1546735OtherGATEWAY HEALTH PLAN
PA1014408560001Medicaid
PA1014408560001Medicaid
PA096771Medicare ID - Type Unspecified