Centerville Clinics Inc
Organization Active NPI Specialist · Coal Center, PA
NPI 1043498280 · NPPES record last updated Oct 18, 2018
Key facts
- NPI
- 1043498280
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- CENTERVILLE CLINICS INC
- Practice address
- California Middle School
40 Trojan Way
Coal Center, PA 15423-1059 - Phone
- (724) 785-5800
- Fax
- (724) 785-8860
- NPI assigned
- Feb 8, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Barry R Niccolai
- Title
- Executive Director
- 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
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 731847
- Legal name
- CENTERVILLE CLINICS, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 7, 2021
- Last certification
- May 7, 2021
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Mar 2, 1953 in PA
- Enrollment address
- 40 Trojan Way
Coal Center, PA 15423-1059
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 Officer |
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 Director |
Oct 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 |
|---|---|---|---|---|
| O20210610002534 | PA | Part a Provider - Federally Qualified Health Center (FQHC) | 7214837202 | Practice locations: Coal Center, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
California Middle School
40 Trojan Way
Coal Center, PA 15423-1059
Mailing address
Centerville Clinics Inc
1070 Old National Pike Road
Fredericktown, PA 15333-2114
Phone (724) 632-6801
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| APPLYING | Medicaid | PA | |
| 328864A859674 | Other | PA | VALUE BEHAVIORAL HEALTH |
Other providers in Coal Center, PA
- Dawn Altman
- Charisse Regene Bowman
- Centerville Clinics Inc
- Centerville Clinics Inc
- Kate Anne Ducarme
- Danielle Hammitt
- Intermediate Unit 1
All providers in Coal Center, PA · Specialist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2018. 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.