Healthcare Provider Details

I. General information

NPI: 1629009295
Provider Name (Legal Business Name): GREENCASTLE FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EASTERN AVE STE 135
GREENCASTLE PA
17225-1100
US

IV. Provider business mailing address

50 EASTERN AVE STE 135
GREENCASTLE PA
17225-1100
US

V. Phone/Fax

Practice location:
  • Phone: 717-597-3151
  • Fax: 717-597-8933
Mailing address:
  • Phone: 717-597-3151
  • Fax: 717-597-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFFER LEE SHOWALTER
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 223-465-2025