Provider Demographics
NPI:1700520855
Name:JOHNSTOWN FREE MEDICAL CLINIC
Entity type:Organization
Organization Name:JOHNSTOWN FREE MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCHANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-534-6242
Mailing Address - Street 1:315 LOCUST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1651
Mailing Address - Country:US
Mailing Address - Phone:814-534-6242
Mailing Address - Fax:814-534-6731
Practice Address - Street 1:315 LOCUST STREET, 2ND FLOOR
Practice Address - Street 2:JOHNSTOWN, PA 15901
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901
Practice Address - Country:US
Practice Address - Phone:814-534-6242
Practice Address - Fax:814-534-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034430240002Medicaid