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General NPI Number Information
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NPI Number | 1104284751
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CARE RURAL HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 550 W WALNUT ST
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City | SHAMOKIN
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State | PA
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Zip | 17872-5226
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Country | US
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Telephone | 570-644-2222
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Fax | 570-648-4705
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Provider Business Mailing Address
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Address Line | 550 W WALNUT ST
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City | SHAMOKIN
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State | PA
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Zip | 17872-5226
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Country | US
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Telephone | 570-644-2222
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Fax | 570-648-4705
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Authorized Official
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Title or Position | MEMBER / ADMINISTRATIVE DIRECTOR
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Name | MS. NADINE MARKOVICH-STEN
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Credential | PA-C
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Telephone | 570-644-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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