Healthcare Provider Details

I. General information

NPI: 1912988452
Provider Name (Legal Business Name): CENTERVILLE CLINICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-632-6801
  • Fax:
Mailing address:
  • Phone: 724-632-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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