Healthcare Provider Details

I. General information

NPI: 1346236833
Provider Name (Legal Business Name): PEDIATRIC CARE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 EISENHOWER BLVD
JOHNSTOWN PA
15904-3307
US

IV. Provider business mailing address

1322 EISENHOWER BLVD
JOHNSTOWN PA
15904-3307
US

V. Phone/Fax

Practice location:
  • Phone: 814-266-8840
  • Fax: 814-266-8840
Mailing address:
  • Phone: 814-266-8840
  • Fax: 814-266-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD-039547-L
License Number StatePA

VIII. Authorized Official

Name: MRS. SHERRI LYNN PARSHALL
Title or Position: BILLING CLERK
Credential:
Phone: 814-266-8840