Healthcare Provider Details

I. General information

NPI: 1902451016
Provider Name (Legal Business Name): JC BLAIR MEDICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/14/2019
Certification Date:
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
16652-2350
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-4876
  • Fax: 814-643-6595
Mailing address:
  • Phone: 814-643-8295
  • Fax: 814-643-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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