Basic Information
| Provider Information | |||||||||
| NPI: | 1508498007 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J C BLAIR MEMORIAL HOSPITAL | ||||||||
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| OtherOrganizationName: | PENN HIGHLANDS HUNTINGDON SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 WARM SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166522350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146432290 | ||||||||
| FaxNumber: | 8146437021 | ||||||||
| Practice Location | |||||||||
| Address1: | 1227 WARM SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166522300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146432290 | ||||||||
| FaxNumber: | 8146437014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2020 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | STRISHOCK | ||||||||
| AuthorizedOfficialFirstName: | JOURDAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ENROLLMENT SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8147712891 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 2086S0102X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.