Provider Demographics
NPI:1891724621
Name:JUNIATA VALLEY GASTROENTEROLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:JUNIATA VALLEY GASTROENTEROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:EVERHART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:717-242-2531
Mailing Address - Street 1:310 ELECTRIC AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1369
Mailing Address - Country:US
Mailing Address - Phone:717-242-2531
Mailing Address - Fax:717-242-1028
Practice Address - Street 1:310 ELECTRIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1369
Practice Address - Country:US
Practice Address - Phone:717-242-2531
Practice Address - Fax:717-242-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1258OtherGEISINGER HEALTH PLAN
PA02407600OtherCAPITAL BLUE CROSS
PA001054982Medicaid
PAF2189OtherRAILROAD MEDICARE
PA001054982Medicaid