1669434064 NPI number — DR BUB & ASSOC FAMILY MEDICAL CENTER

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 1669434064 NPI number — DR BUB & ASSOC FAMILY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR BUB & ASSOC FAMILY MEDICAL CENTER
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:
1669434064
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:
623 E BROAD ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18018-6332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-965-6048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 DALTON 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:
18049-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-967-3646
Provider Business Practice Location Address Fax Number:
610-966-8238
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHYSICIAN GROUP
Authorized Official First Name:
ST LUKES
Authorized Official Middle Name:
Authorized Official Title or Position:
SLPG
Authorized Official Telephone Number:
610-965-6048

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)





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