Healthcare Provider Details

I. General information

NPI: 1477784106
Provider Name (Legal Business Name): CLEAR MED PROVIDER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 TURNPIKE AVE
CLEARFIELD PA
16830-1233
US

IV. Provider business mailing address

809 TURNPIKE AVE
CLEARFIELD PA
16830-1232
US

V. Phone/Fax

Practice location:
  • Phone: 814-765-2006
  • Fax: 814-765-8807
Mailing address:
  • Phone: 814-768-2356
  • Fax: 814-768-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005951
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RITA V OLSZEWSKI
Title or Position: CLEAR MED ADMINISTRATOR
Credential:
Phone: 814-768-2356