Healthcare Provider Details

I. General information

NPI: 1003298985
Provider Name (Legal Business Name): JC BLAIR MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 WARM SPRINGS AVE SUITE 202
HUNTINGDON PA
16652-2300
US

IV. Provider business mailing address

1225 WARM SPRINGS AVE
HUNTINGDON PA
16652-2350
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-4878
  • Fax: 814-643-7043
Mailing address:
  • Phone: 814-643-7082
  • Fax: 814-643-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH SHUGHARTS
Title or Position: CFO
Credential:
Phone: 814-643-8445