Provider Demographics
NPI:1730108994
Name:CLEARFIELD PROFESSIONAL GROUP, LTD.
Entity type:Organization
Organization Name:CLEARFIELD PROFESSIONAL GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:WITHEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-765-5796
Mailing Address - Street 1:820 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1229
Mailing Address - Country:US
Mailing Address - Phone:814-765-2412
Mailing Address - Fax:814-765-8807
Practice Address - Street 1:820 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1229
Practice Address - Country:US
Practice Address - Phone:814-765-2412
Practice Address - Fax:814-765-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011097860011Medicaid
PA0011097860011Medicaid