Basic Information
| Provider Information | |||||||||
| NPI: | 1134198666 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY PHYSICIAN ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 TIRE HILL ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144674055 | ||||||||
| FaxNumber: | 8142628161 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 BRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW CUMBERLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170701127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177747041 | ||||||||
| FaxNumber: | 7177743213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | YENTZER | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7172261665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0006372460001 | 05 | PA | MEDICAID |