Healthcare Provider Details

I. General information

NPI: 1710951033
Provider Name (Legal Business Name): ALTOONA SPECIALITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 OLD ROUTE 220 NORTH
DUNCANSVILLE PA
16635
US

IV. Provider business mailing address

PO BOX 909
DUNCANSVILLE PA
16635
US

V. Phone/Fax

Practice location:
  • Phone: 814-693-0300
  • Fax: 814-693-0400
Mailing address:
  • Phone: 814-693-0300
  • Fax: 814-693-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1864
License Number StatePA

VIII. Authorized Official

Name: DR. ALAN J KIVITZ
Title or Position: CEO/CFO
Credential: MD
Phone: 814-693-0300