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NPI Code Detail

MEDICARE: CLEAR MED PROVIDER CORPORATION

MEDICARE: CLEAR MED PROVIDER CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD046900LPA
2207Q00000XFamily Medicine PhysicianOS005364LPA
3363A00000XPhysician AssistantMA051447PA
4363A00000XPhysician AssistantOA002454PA
5261QH0100XHealth Service Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10166056OTHERPAHIGHMARK BCBS ASSIGNMENT ACCOUNT

General Provider Information

NPI Number : 1083872766
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEAR MED PROVIDER CORPORATION
Provider Business Mailing Address
First Line : 809 TURNPIKE AVE
Second Line :
City : CLEARFIELD
State : PA
Zip : 16830-1232
Country : US
Telephone Number : 814-768-2356
Fax Number : 814-768-2134
Provider Business Practice Location Address
First Line : 1049 N FRONT ST
Second Line :
City : PHILIPSBURG
State : PA
Zip : 16866-8258
Country : US
Telephone Number : 814-342-9701
Fax Number : 814-342-7056
Authorized Official
Title or Position : CLEAR MED ADMINISTRATOR
Name : RITA V OLSZEWSKI
Credential :
Telephone Number : 814-768-2356
Provider Enumeration Date : 05/29/2008
Last Update Date : 09/02/2010

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Directions to “CLEAR MED PROVIDER CORPORATION ” Practice Location

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