Fairfield Ave Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAIRFIELD AVE FAMILY PRACTICE

Practice address

226 Fairfield Ave
Johnstown, PA 15906-2310

Phone

(814) 535-6167

NPI assigned

May 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Carol Elizabeth Kowtoniuk, D.O.

Title

Vice President

Phone

(814) 535-6167

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1114130929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 FAIRFIELD AVE",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159062310",
            "telephone_number": "814-535-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 FAIRFIELD AVE",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159062310",
            "telephone_number": "814-535-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD AVE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "KOWTONIUK",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "814-535-6167",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007300380005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.