Basic Information
| Provider Information | |||||||||
| NPI: | 1619050085 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KALATA FAMILY PRACTICE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 404 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165031204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144541851 | ||||||||
| FaxNumber: | 8144558313 | ||||||||
| Practice Location | |||||||||
| Address1: | 404 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165031204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144541851 | ||||||||
| FaxNumber: | 8144558313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2006 | ||||||||
| LastUpdateDate: | 09/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | KALATA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8144541851 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS006320L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0005713500001 | 05 | PA | MEDICAID | 675253 | 01 | PA | KEYSTONE | OTHER |