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General NPI Number Information
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NPI Number | 1235204611
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Entity Type | Organization
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Legal Business Name | CLEARFIELD JEFFERSON HEAD AND NECK SURGICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 871 BEAVER DR
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City | DU BOIS
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State | PA
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Zip | 15801-2511
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Country | US
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Telephone | 814-375-0455
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Fax | 814-375-2721
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Provider Business Mailing Address
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Address Line | 871 BEAVER DR PO BOX 308
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City | DU BOIS
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State | PA
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Zip | 15801-2511
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Country | US
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Telephone | 814-375-0455
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Fax | 814-375-2721
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY JAMES ROSCOE
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Credential | DMD, MD
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Telephone | 814-375-0455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AT006006
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AT006006
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD038440L
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License Number State | PA
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