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General NPI Number Information
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NPI Number | 1346145653
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Entity Type | Organization
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Legal Business Name | VINTAGE MEDICAL INC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 201 HOSPITAL DR STE 3
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City | EVERETT
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State | PA
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Zip | 15537-7019
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Country | US
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Telephone | 814-925-2006
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Fax |
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Provider Business Mailing Address
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Address Line | 217 BOHN RD
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City | BEDFORD
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State | PA
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Zip | 15522-6822
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Country | US
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Telephone | 814-925-2006
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CURVIN LEE GORDON
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Credential | PA-C
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Telephone | 814-925-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | NULL
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