Healthcare Provider Details

I. General information

NPI: 1740301746
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES OF HAZLETON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 N CHURCH ST
HAZLETON PA
18201-1800
US

IV. Provider business mailing address

943 N CHURCH ST
HAZLETON PA
18201-1800
US

V. Phone/Fax

Practice location:
  • Phone: 800-503-1664
  • Fax:
Mailing address:
  • Phone: 800-503-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009123L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SALVATORE SPARICH
Title or Position: CEO
Credential: DO
Phone: 800-503-1664