Provider Demographics
NPI:1730534595
Name:PUNXSUTAWNEY MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:PUNXSUTAWNEY MEDICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-938-1882
Mailing Address - Street 1:81 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-3343
Mailing Address - Fax:814-938-3369
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-3343
Practice Address - Fax:814-938-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015479580004Medicaid
PA0015479580004Medicaid