Provider Demographics
NPI:1154393544
Name:COLONIAL CLINIC, P.C.
Entity type:Organization
Organization Name:COLONIAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRONEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-353-1508
Mailing Address - Street 1:706 EKASTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9724
Mailing Address - Country:US
Mailing Address - Phone:724-353-1508
Mailing Address - Fax:724-353-2040
Practice Address - Street 1:706 EKASTOWN RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9724
Practice Address - Country:US
Practice Address - Phone:724-353-1508
Practice Address - Fax:724-353-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008948L291U00000X
PAOS003532L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
G20043Medicare UPIN
PAB37248Medicare UPIN