Healthcare Provider Details

I. General information

NPI: 1427096577
Provider Name (Legal Business Name): IRWIN FAMILY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
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
IRWIN 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 TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAWDAT A NIKOULA
Title or Position: MD/ OWNER
Credential: MD
Phone: 724-864-9595