Healthcare Provider Details

I. General information

NPI: 1063670479
Provider Name (Legal Business Name): CLEAR MED PROVIDER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 TURNPIKE AVE
CLEARFIELD PA
16830-3061
US

IV. Provider business mailing address

809 TURNPIKE AVE
CLEARFIELD PA
16830-1232
US

V. Phone/Fax

Practice location:
  • Phone: 814-768-2137
  • Fax: 814-768-2084
Mailing address:
  • Phone: 814-768-2356
  • Fax: 814-768-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051098
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP010448
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW000309L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015281
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW013007L
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

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