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General NPI Number Information
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NPI Number | 1477743409
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Entity Type | Organization
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Legal Business Name | BRUCE M LIDSTON AND ALLEN B ETTENGER PARTNERS
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 1227 WARM SPRINGS AVE SUITE 301
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City | HUNTINGDON
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State | PA
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Zip | 16652-2300
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Country | US
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Telephone | 814-643-0531
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Fax | 814-643-6637
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Provider Business Mailing Address
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Address Line | 1227 WARM SPRINGS AVE SUITE 301
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City | HUNTINGDON
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State | PA
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Zip | 16652-2300
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Country | US
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Telephone | 814-643-0531
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Fax | 814-643-6637
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Authorized Official
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Title or Position | PARTNER
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Name | BRUCE M LIDSTON
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Credential | MD
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Telephone | 814-643-0531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 010231
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License Number State | PA
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