Basic Information
| Provider Information | |||||||||
| NPI: | 1003855693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY HEALTH ASSOCIATES OF LEWISTOWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | LEWISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170441167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172427722 | ||||||||
| FaxNumber: | 7172427712 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | LEWISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170441167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172427722 | ||||||||
| FaxNumber: | 7172427712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOBB | ||||||||
| AuthorizedOfficialFirstName: | CRISTA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FHA OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7172427103 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAMILY HEALTH ASSOCIATES OF LEWISTOWN | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.