Basic Information
Provider Information
NPI: 1679859615
EntityType: 2
ReplacementNPI:  
OrganizationName: CONEMAUGH HEALTH INITIATIVES
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CONEMAUGH PHYSICIAN GROUP-FAMILY MEDICINE-DAVIDSVILLE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1086 FRANKLIN ST
Address2:  
City: JOHNSTOWN
State: PA
PostalCode: 159054305
CountryCode: US
TelephoneNumber: 8145341643
FaxNumber: 8145341396
Practice Location
Address1: 207 WOODSTOWN HWY
Address2:  
City: HOLLSOPPLE
State: PA
PostalCode: 159357119
CountryCode: US
TelephoneNumber: 8144794034
FaxNumber: 8144797166
Other Information
ProviderEnumerationDate: 10/21/2011
LastUpdateDate: 10/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LAMBERT
AuthorizedOfficialFirstName: ELAINE
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8145341678
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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