MEDICARE: JC BLAIR OBGYN ASSOCIATES LTD

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
1	207V00000X	Obstetrics & Gynecology Physician		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16540	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1104859834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JC BLAIR OBGYN ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	1227 WARM SPRINGS AVE
Second Line	:	SUITE 302
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-2300
Country	:	US
Telephone Number	:	814-643-3808
Fax Number	:	814-643-8272

Provider Business Practice Location Address
First Line	:	1227 WARM SPRINGS AVE
Second Line	:	SUITE 302
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-2300
Country	:	US
Telephone Number	:	814-643-3808
Fax Number	:	814-643-8272

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KENNETH KYUNG YUN LEE
Credential	:	M.D.
Telephone Number	:	814-643-3808

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/21/2022

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1831194497 — DR. CHRISTOPHER JAMES PATITSAS M.D.
Practice Location Address:

1227 WARM SPRINGS AVE , STE 303
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1124016811 — DR. TODD ALAN FORTNEY PHARMD, RPH
Practice Location Address:

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1770557282 — MRS. STEPHANIE ANNE GALLOWAY-MASLANIK LCSW, RPT-S
Practice Location Address:

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Practice Location Address:

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Practice Location Address:

1227 WARM SPRINGS AVE , J.C. BLAIR PHYSICIAN'S BUILDING #301
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1285664953 — BRUCE M LIDSTON AND ALLEN B ETTENGER PARTNERS
Practice Location Address:

1227 WARM SPRINGS AVE STE 301
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