NPIMap

Organization Active NPI

Centerville Clinics, Inc Connellsville MH

  • Specialist
  • Connellsville, PA
National Provider Identifier
1790951655
Registry record updated May 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CENTERVILLE CLINICS, INC CONNELLSVILLE MH
Practice address
208 S Arch St
Connellsville, PA 15425-3519
Phone
(724) 626-2630
NPI assigned
May 1, 2008
Last updated
May 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2008

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 and Personnel
Phone
(724) 632-6801

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 391911 PA
Specialist 174400000X Primary

Addresses

Primary practice location

208 S Arch St
Connellsville, PA 15425-3519

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
1007288440037MedicaidPA
328834A776089OtherPAVALUE BEHAVIORAL HEALTH
391911OtherPANATIONAL GOVERNMENT SERVICES

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1790951655",
    "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": "208 S ARCH ST",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154253519",
            "telephone_number": "724-626-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE CLINICS, INC CONNELLSVILLE MH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "MARTOS",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "DIRECTOR FINANCE AND 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": "391911",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288440037",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE BEHAVIORAL HEALTH",
            "identifier": "328834A776089",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL GOVERNMENT SERVICES",
            "identifier": "391911",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Connellsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; 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.