Healthcare Provider Details

I. General information

NPI: 1275150682
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

820 BRYAN ST STE 3
HUNTINGDON PA
16652-2409
US

IV. Provider business mailing address

1225 WARM SPRINGS AVE
HUNTINGDON PA
16652-2398
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-4876
  • Fax: 814-643-6595
Mailing address:
  • Phone: 814-643-4876
  • Fax: 814-643-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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