Healthcare Provider Details

I. General information

NPI: 1750419305
Provider Name (Legal Business Name): PUNXSUTAWNEY MEDICAL SERVICES-OBGYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 N MAIN ST SUITE 14
PUNXSUTAWNEY PA
15767-2609
US

IV. Provider business mailing address

81 HILLCREST DR
PUNXSUTAWNEY PA
15767-2605
US

V. Phone/Fax

Practice location:
  • Phone: 814-938-3343
  • Fax: 814-938-3369
Mailing address:
  • Phone: 814-938-1450
  • Fax: 814-938-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD 424295
License Number StatePA

VIII. Authorized Official

Name: JACK SISK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 814-938-1882