1700228806 NPI number — MILL CREEK FAMILY PRACTICE, PA

Table of content: MS. JENNEFER LEAH KOLINAC LMT (NPI 1194966986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700228806 NPI number — MILL CREEK FAMILY PRACTICE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILL CREEK FAMILY PRACTICE, PA
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:
1700228806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16150 US HIGHWAY 17 N STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28443-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-270-2515
Provider Business Mailing Address Fax Number:
910-270-3544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16150 US HIGHWAY 17 N STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPSTEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28443-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-270-2515
Provider Business Practice Location Address Fax Number:
910-270-3544
Provider Enumeration Date:
07/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FARMER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-270-2515

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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