MEDICARE: CONNEAUT VALLEY HEALTH CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	OS011018L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	191386	OTHER	PA	HIGHMARK BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427133248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNEAUT VALLEY HEALTH CENTER INC.

Provider Business Mailing Address
First Line	:	1034 GROVE ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2945
Country	:	US
Telephone Number	:	814-373-2449
Fax Number	:	814-373-3050

Provider Business Practice Location Address
First Line	:	10926 HIGHWAY 18
Second Line	:
City	:	CONNEAUT LAKE
State	:	PA
Zip	:	16316-3526
Country	:	US
Telephone Number	:	814-382-0446
Fax Number	:	814-382-7386

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL DOWNING
Credential	:
Telephone Number	:	814-373-2449

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/10/2014

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