Provider Demographics
NPI:1487300893
Name:MATURE RESOURCES FOUNDATION
Entity type:Organization
Organization Name:MATURE RESOURCES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-577-9385
Mailing Address - Street 1:PO BOX 986500
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6500
Mailing Address - Country:US
Mailing Address - Phone:814-765-2695
Mailing Address - Fax:
Practice Address - Street 1:1924 DAISY STREET EXT REAR SUITEA
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3201
Practice Address - Country:US
Practice Address - Phone:814-765-2695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATURE RESOURCES FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty