Healthcare Provider Details

I. General information

NPI: 1851330658
Provider Name (Legal Business Name): IRWIN FAMILY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SPRUCE ST STE 201
IRWIN PA
15642-3683
US

IV. Provider business mailing address

905 SPRUCE ST
N HUNTINGDON PA
15642-3683
US

V. Phone/Fax

Practice location:
  • Phone: 724-864-9595
  • Fax: 724-864-9860
Mailing address:
  • Phone: 724-864-9595
  • Fax: 724-864-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAWDAT A NIKOULA
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 724-832-7887