Healthcare Provider Details

I. General information

NPI: 1225047335
Provider Name (Legal Business Name): CRAWFORD COUNTY SUB-SPECIALISTS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ALDEN ST
MEADVILLE PA
16335-2348
US

IV. Provider business mailing address

640 ALDEN ST
MEADVILLE PA
16335-2348
US

V. Phone/Fax

Practice location:
  • Phone: 814-724-1252
  • Fax: 814-333-8871
Mailing address:
  • Phone: 814-724-1252
  • Fax: 814-333-8871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: MRS. KAY A. HIGBY
Title or Position: OFFICE MANAGER
Credential:
Phone: 814-724-1252