Provider Demographics
NPI:1932129368
Name:MEDICAL GROUP OF CORRY, INC
Entity Type:Organization
Organization Name:MEDICAL GROUP OF CORRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-664-8686
Mailing Address - Street 1:315 YORK ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1412
Mailing Address - Country:US
Mailing Address - Phone:814-664-8686
Mailing Address - Fax:814-664-9826
Practice Address - Street 1:315 YORK ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1412
Practice Address - Country:US
Practice Address - Phone:814-664-8686
Practice Address - Fax:814-664-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA463990OtherHIGHMARK BLUE SHIELD
PA0006472600016Medicaid
PA393889Medicare Oscar/Certification
PA463990OtherHIGHMARK BLUE SHIELD