Provider Demographics
NPI:1285986950
Name:PUNXSUTAWNEY MEDICAL SERVICES-SURGICAL DIVISION
Entity type:Organization
Organization Name:PUNXSUTAWNEY MEDICAL SERVICES-SURGICAL DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:UBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-938-1451
Mailing Address - Street 1:81 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-1451
Mailing Address - Fax:814-938-1453
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-1451
Practice Address - Fax:814-938-1453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUNXSUTAWNEY AREA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015479580004Medicaid