1639201023 NPI number — GREENCASTLE FAMILY PRACTICE, PC

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 1639201023 NPI number — GREENCASTLE FAMILY PRACTICE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENCASTLE FAMILY PRACTICE, 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:
6
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:
1639201023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 EASTERN AVE
Provider Second Line Business Mailing Address:
SUITE 135
Provider Business Mailing Address City Name:
GREENCASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17225-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-597-0095
Provider Business Mailing Address Fax Number:
717-597-3147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 EASTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
GREENCASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17225-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-597-0095
Provider Business Practice Location Address Fax Number:
717-597-3147
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHOWALTER
Authorized Official First Name:
JENNIFFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXEC ASSISTANT
Authorized Official Telephone Number:
223-465-2025

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PS008907L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: PC000234 , 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: 50001005 . This is a "CAPITAL BLUE CROSS GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 706786 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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