Basic Information
| Provider Information | |||||||||
| NPI: | 1285090951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SECURITY FAMILY MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1930 SECURITY DR | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174024727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177414641 | ||||||||
| FaxNumber: | 7177419198 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 SECURITY DR | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174024727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177414641 | ||||||||
| FaxNumber: | 7177419198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2016 | ||||||||
| LastUpdateDate: | 01/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | ADRIENNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7177414641 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD066211L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.