Centerville Clinics, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Republic, PA
NPI 1043430267 · NPPES record last updated Jul 22, 2010
Key facts
- NPI
- 1043430267
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTERVILLE CLINICS, INC.
- Practice address
- 1006 Main Street,
Republic, PA 15475 - Phone
- (724) 246-9434
- Fax
- (724) 246-9846
- NPI assigned
- Apr 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Patty Martos
- Title
- Director Personel Finance
- Phone
- (724) 632-6801
Owners & managing parties with NPI records 1
-
Daniel Lee Holt, M.D.
Other NPIs with the same Medicare PAC ID 23
Corporate family (same tax ID) 18
Practitioners 44
-
Susan Elizabeth Albert, CRNP
-
Crystal Lynn Andrews, CRNP
-
Shweta Arora, MD
-
Thais Irene Bagiatis, LPC
-
Maria R Bening, MD
-
Lisa A Bodnar, M.S.E.
-
Charles Richard Brown, D.O.
-
Alvaro N Changco, MD
-
Darcie Lynn Coen, LPC
-
Michelle M Cohen, CRNP
-
Carolyn J Cooper, PC
-
Coreyann Fluker, NP
-
Nicole Goodwin, LPC
-
Danielle M Guerrieri, CRNP
-
Daniel Lee Holt, M.D.
-
Angela Kalia, MD
-
Bryce James Kesling, FNP-C
-
Tara Spain Lemaire, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Federally qualified health center certification: CCN 391807
- Legal name
- CENTERVILLE CLINICS, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 1, 1992
- Last certification
- Aug 1, 1992
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 2, 1953 in PA
- Enrollment address
- 1006 Main St
Republic, PA 15475-1012
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Daniel L Holt |
W-2 Managing Employee | Jan 1, 2011 | |
| Donna Salvino |
Corporate Director |
Aug 25, 2014 | |
| Edward J Marotta |
Corporate Director |
Nov 17, 2014 | |
| Barry R Niccolai |
Corporate Director |
Apr 1, 2017 | |
| W-2 Managing Employee |
Apr 1, 2017 | ||
| Patricia a Gavazzi |
Corporate Director |
Jun 27, 2017 | |
| Darra Tyler-Owens |
Corporate Director |
Sep 29, 2018 | |
| Andrew Corfont |
Corporate Director |
Mar 25, 2013 | |
| Joseph M Yablonski |
Corporate Officer |
Nov 23, 2004 | |
| Patricia Martos |
W-2 Managing Employee |
Mar 1, 1979 | |
| James T Yablonski |
Corporate Director |
Jan 23, 1995 | |
| Marianne E Gideon |
Corporate Director |
Jun 27, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090930000423 | PA | Part a Provider - Federally Qualified Health Center (FQHC) | 7214837202 | Practice locations: Republic, PA |
National Provider Directory
- Tax ID family
- Centerville Clinics Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | PA | Yes |
Addresses
Primary practice location
1006 Main Street,
Republic, PA 15475
Mailing address
1070 Old National Pike
Fredericktown, PA 15333-2114
Phone (724) 632-6801
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007288440032 | Medicaid | PA |
Other providers in Republic, PA
All providers in Republic, PA · Federally Qualified Health Center (FQHC) in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.