Healthcare Provider Details

I. General information

NPI: 1437277373
Provider Name (Legal Business Name): PRIMARY CARE CENTER OF MT MORRIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FRONT STREET SUITE 102
MOUNT MORRIS PA
15349-0495
US

IV. Provider business mailing address

104 FRONT STREET SUITE 102
MOUNT MORRIS PA
15349-0495
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MTJOY
Title or Position: CEO
Credential: CEO
Phone: 724-943-3308