Healthcare Provider Details

I. General information

NPI: 1184775140
Provider Name (Legal Business Name): PENNS VALLEY AREA MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 PENNS VALLEY RD SUITE 1
SPRING MILLS PA
16875-8500
US

IV. Provider business mailing address

4570 PENNS VALLEY RD SUITE 1
SPRING MILLS PA
16875-8500
US

V. Phone/Fax

Practice location:
  • Phone: 814-422-8873
  • Fax:
Mailing address:
  • Phone: 814-422-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0015077740004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: WILLIAM E YOUNG
Title or Position: PRESIDENT
Credential: DO
Phone: 814-422-8873