Healthcare Provider Details

I. General information

NPI: 1710969019
Provider Name (Legal Business Name): CENTERVILLE CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 N MORGANTOWN ST
FAIRCHANCE PA
15436-1039
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-564-0900
  • Fax: 724-564-9835
Mailing address:
  • Phone: 724-632-6801
  • Fax: 724-632-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA MARTOS
Title or Position: DIRECTOR OF FINANCE/PERSONNEL
Credential:
Phone: 724-632-6801