Basic Information
| Provider Information | |||||||||
| NPI: | 1073516720 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONEMAUGH HEALTH INITIATIVES | ||||||||
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| OtherOrganizationName: | CHI PAUL A. ROLLINS, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1086 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159054305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144108300 | ||||||||
| FaxNumber: | 8144108331 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 LOCUST ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159011651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145346750 | ||||||||
| FaxNumber: | 8145346760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2005 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | LAMBERT | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8145341630 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1007358110035 | 05 | PA | MEDICAID |