Healthcare Provider Details

I. General information

NPI: 1164049573
Provider Name (Legal Business Name): JC BLAIR MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BRYAN ST STE 7
HUNTINGDON PA
16652-2413
US

IV. Provider business mailing address

1225 WARM SPRINGS AVE
HUNTINGDON PA
16652-2398
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-1141
  • Fax: 814-643-9451
Mailing address:
  • Phone: 814-643-1141
  • Fax: 814-643-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TONI HETRICK
Title or Position: INSURANCE CREDENTIALING TECHNICIAN
Credential:
Phone: 814-643-8295