Healthcare Provider Details

I. General information

NPI: 1982667770
Provider Name (Legal Business Name): CENTRE MEDICAL AND SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S ATHERTON ST SUITE 2
STATE COLLEGE PA
16801-8324
US

IV. Provider business mailing address

3901 S ATHERTON ST SUITE 2
STATE COLLEGE PA
16801-8324
US

V. Phone/Fax

Practice location:
  • Phone: 814-466-2300
  • Fax: 814-466-2822
Mailing address:
  • Phone: 814-466-2300
  • Fax: 814-466-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD021110E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier73303
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name: JOHN J. MCQUEARY
Title or Position: COO/ADMINISTRATIVE DIRECTOR
Credential:
Phone: 814-234-4753