MEDICARE: PORT ALLEGANY AREA FAMILY PRACTICE PC

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	207Q00000X	Family Medicine Physician	MD029656E	PA
2	363AM0700X	Medical Physician Assistant	MA053689	PA
3	363LF0000X	Family Nurse Practitioner	SP008214	PA
4	363LF0000X	Family Nurse Practitioner	SP009929	PA
5	261QR1300X	Rural Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF9006	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	861827	OTHER	PA	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1962469486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT ALLEGANY AREA FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	1 WILLOW ST
Second Line	:
City	:	PORT ALLEGANY
State	:	PA
Zip	:	16743-1332
Country	:	US
Telephone Number	:	814-642-9531
Fax Number	:	814-642-2020

Provider Business Practice Location Address
First Line	:	1 WILLOW ST
Second Line	:
City	:	PORT ALLEGANY
State	:	PA
Zip	:	16743-1332
Country	:	US
Telephone Number	:	814-642-9531
Fax Number	:	814-642-2020

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK H SHELLEY
Credential	:	M.D.
Telephone Number	:	814-642-9531

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	06/22/2022

Similar Medicare Providers

1336106954 — MARK H SHELLEY M.D.
Practice Location Address:

1 WILLOW ST
PORT ALLEGANY, PA
16743-1332

Practice Phone: 814-642-9531
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1821724139 — HEATHER DEIMLER KIO CRNP
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PORT ALLEGANY, PA
16743-1332

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1235139015 — THAD NATHAN DIEHL D.C.
Practice Location Address:

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1366442535 — EDWIN M SCHOTT OD
Practice Location Address:

21 WILLOW ST
PORT ALLEGANY, PA
16743-1334

Practice Phone: 814-642-9408
Practice Fax:

1801848700 — DANIEL E SCHOTT OD
Practice Location Address:

21 WILLOW ST
PORT ALLEGANY, PA
16743-1334

Practice Phone: 814-642-9408
Practice Fax: 814-642-9484

1962455352 — EDWIN M SCHOTT OD PC
Practice Location Address:

21 WILLOW ST
PORT ALLEGANY, PA
16743-1334

Practice Phone: 814-642-9408
Practice Fax: 814-642-9484

Directions to “PORT ALLEGANY AREA FAMILY PRACTICE PC ” Practice Location

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