Healthcare Provider Details

I. General information

NPI: 1578567061
Provider Name (Legal Business Name): CHAMBERS FAMILY HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 MAIN ST
BROOKVILLE PA
15825-1251
US

IV. Provider business mailing address

298 MAIN ST
BROOKVILLE PA
15825-1251
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-5288
  • Fax: 814-849-5819
Mailing address:
  • Phone: 814-849-5288
  • Fax: 814-849-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD065092L
License Number StatePA

VIII. Authorized Official

Name: MR. GREGORY A CHAMBERS
Title or Position: PRACTICE MANAGER, VP
Credential:
Phone: 814-849-5288