Basic Information
| Provider Information | |||||||||
| NPI: | 1134227655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONEMAUGH HEALTH INITIATIVES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHI KEVIN SUGALSKI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1086 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159054305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145358885 | ||||||||
| FaxNumber: | 8142552961 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 SCALP AVE | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159043374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142661189 | ||||||||
| FaxNumber: | 8142666375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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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 | 207Q00000X | OS011040L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.