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General NPI Number Information
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NPI Number | 1619236056
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Entity Type | Organization
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Legal Business Name | MEADVILLE PHYSICIAN SERVICES
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 765 LIBERTY ST STE 101
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City | MEADVILLE
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State | PA
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Zip | 16335-2566
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Country | US
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Telephone | 814-373-3434
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Fax | 814-373-2152
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Provider Business Mailing Address
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Address Line | 1034 GROVE ST
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City | MEADVILLE
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State | PA
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Zip | 16335-2945
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Country | US
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Telephone | 814-373-3545
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Fax | 814-333-5640
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Authorized Official
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Title or Position | CFO
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Name | RENATO SUNTAY
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Credential |
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Telephone | 814-333-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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