Healthcare Provider Details

I. General information

NPI: 1346145653
Provider Name (Legal Business Name): VINTAGE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOSPITAL DR STE 3
EVERETT PA
15537-7019
US

IV. Provider business mailing address

217 BOHN RD
BEDFORD PA
15522-6822
US

V. Phone/Fax

Practice location:
  • Phone: 814-925-2006
  • Fax:
Mailing address:
  • Phone: 814-925-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CURVIN LEE GORDON
Title or Position: ADMINISTRATOR
Credential: PA-C
Phone: 814-925-2006