Healthcare Provider Details

I. General information

NPI: 1871535351
Provider Name (Legal Business Name): ALLEGHENIES INDEPENDENT PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 BLOOMFIELD ST STE 201
JOHNSTOWN PA
15904-3271
US

IV. Provider business mailing address

336 BLOOMFIELD ST STE 201
JOHNSTOWN PA
15904-3271
US

V. Phone/Fax

Practice location:
  • Phone: 814-535-7576
  • Fax: 814-536-1369
Mailing address:
  • Phone: 814-535-7576
  • Fax: 814-536-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS005422L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD059909L
License Number StatePA

VIII. Authorized Official

Name: CRAIG H FOCKLER
Title or Position: PRESIDENT
Credential:
Phone: 814-266-5650