1902451016 NPI number — JC BLAIR MEDICAL SERVICES INC.

Table of content: DR. OMAR RIVERA MOJICA O.D. (NPI 1639339427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902451016 NPI number — JC BLAIR MEDICAL SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JC BLAIR MEDICAL SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PENN HIGHLANDS MEDICAL SERVICES INC SURGICAL CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902451016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 WARM SPRINGS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16652-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-643-8295
Provider Business Mailing Address Fax Number:
814-643-7021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 BRYAN ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-4876
Provider Business Practice Location Address Fax Number:
814-643-6595
Provider Enumeration Date:
08/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HETRICK
Authorized Official First Name:
TONI
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE ENROLLMENT
Authorized Official Telephone Number:
814-643-8295

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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