1730238494 NPI number — FAMILY DOCTOR, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730238494 NPI number — FAMILY DOCTOR, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY DOCTOR, 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:
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:
1730238494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMMAUS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18049-1952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-966-5549
Provider Business Mailing Address Fax Number:
610-967-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMAUS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18049-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-966-5549
Provider Business Practice Location Address Fax Number:
610-967-0204
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEID
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-966-5549

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02349800 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 875361 . This is a "PA. BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E1BB . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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