Provider Demographics
NPI:1538374665
Name:MEDAID, INC.
Entity type:Organization
Organization Name:MEDAID, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVYAC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-654-4545
Mailing Address - Street 1:573 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1307
Mailing Address - Country:US
Mailing Address - Phone:724-946-9631
Mailing Address - Fax:
Practice Address - Street 1:527 E LONG AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4843
Practice Address - Country:US
Practice Address - Phone:724-654-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006255L261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018780010001Medicaid