Basic Information
| Provider Information | |||||||||
| NPI: | 1013218270 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KEYSTONE RURAL HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KEYSTONE INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CHAMBERS HILL DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172017304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177097922 | ||||||||
| FaxNumber: | 7172632055 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 NORLAND AVE. | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176804 | ||||||||
| FaxNumber: | 7172176896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2010 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | COCHRAN | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDEN AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 7177097906 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.