NPIMap

Organization Active NPI

Centerville Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fairchance, PA
National Provider Identifier
1003037201
Registry record updated Oct 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTERVILLE CLINICS, INC.
Practice address
93 N Morgantown St
Fairchance, PA 15436-1039
Phone
(724) 564-0900
Fax
(724) 564-9835
NPI assigned
May 2, 2007
Last updated
Oct 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Patty Martos
Title
Director Finance Personnel
Phone
(724) 632-6801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X PA Primary

Addresses

Primary practice location

93 N Morgantown St
Fairchance, PA 15436-1039

Mailing address

1070 Old National Pike
Fredericktown, PA 15333-2114
Phone (724) 632-6801

Other identifiers 1

IdentifierTypeStateIssuer
1007288440031MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090930000525 PA Part A Provider - Federally Qualified Health Center (FQHC) 7214837202 Practice locations: Fairchance, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003037201. Details of each certification follow.

Federally qualified health center certification: CCN 391860

Legal name
CENTERVILLE CLINICS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 25, 1994
Last certification
Feb 25, 1994
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 2, 1953 in PA
Enrollment address
93 N Morgantown St
Fairchance, PA 15436-1039
Related CCNs
391812

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Centerville Clinics Inc66 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniel L Holt Individual Corporate DirectorMedical Director May 1, 2015
Donna Salvino Individual Corporate DirectorSecretary/Treasurer Nov 17, 2014
Edward J Marotta Individual Corporate DirectorBoard Member Nov 17, 2014
Barry R Niccolai Individual Corporate DirectorCeo Apr 1, 2017
W-2 Managing EmployeeManaging Employee. Apr 1, 2017
Patricia a Gavazzi Individual Corporate DirectorBoard Member Jun 27, 2017
Darra Tyler-Owens Individual Corporate DirectorBoard Member Sep 28, 2018
Andrew Corfont Individual Corporate DirectorVice President Nov 17, 2014
Joseph M Yablonski Individual Corporate DirectorPresident of Board Nov 23, 2024
Patricia Martos Individual Corporate DirectorDirector Finance/Personnel Mar 1, 1979
W-2 Managing EmployeeDirector of Finance Mar 1, 1979
Marianne E Gideon Individual Corporate DirectorBoard Member Jun 27, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256688000000",
    "number": "1003037201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 N MORGANTOWN ST",
            "city": "FAIRCHANCE",
            "state": "PA",
            "postal_code": "154361039",
            "telephone_number": "724-564-0900",
            "fax_number": "724-564-9835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2009-10-28",
        "status": "A",
        "authorized_official_last_name": "MARTOS",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "DIRECTOR FINANCE PERSONNEL",
        "authorized_official_telephone_number": "724-632-6801",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288440031",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairchance, PA

Sources for this page

Verify at the official NPI Registry.