Healthcare Provider Details

I. General information

NPI: 1649412941
Provider Name (Legal Business Name): PRIMARY CARE CENTER OF MOUNT MORRIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FRONT STREET SUITE VAN 1
MOUNT MORRIS PA
15349-0495
US

IV. Provider business mailing address

PO BOX 495
MOUNT MORRIS PA
15349-0495
US

V. Phone/Fax

Practice location:
  • Phone: 888-454-5064
  • Fax: 724-324-9005
Mailing address:
  • Phone: 724-324-9001
  • Fax: 724-324-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MT. JOY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 724-324-9001