1609867449 NPI number — DOUGLAS A. SPOTTS, MD FAMILY MEDICAL CARE, PC

Table of content: (NPI 1609867449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609867449 NPI number — DOUGLAS A. SPOTTS, MD FAMILY MEDICAL CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS A. SPOTTS, MD FAMILY MEDICAL CARE, PC
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:
Provider Other Organization Name Type Code:
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:
1609867449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 FORESTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17837-6213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-524-5050
Provider Business Mailing Address Fax Number:
570-524-5250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 FORESTWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-6213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-5050
Provider Business Practice Location Address Fax Number:
570-524-5250
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SPOTTS
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-524-5050

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD058238L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1475996 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 210181 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50016191 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1475996 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20724 . This is a "GHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015761540005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1475996 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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