Healthcare Provider Details

I. General information

NPI: 1750346441
Provider Name (Legal Business Name): SCHUYLKILL VALLEY FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S CENTRE AVENUE
LEESPORT PA
19533
US

IV. Provider business mailing address

PO BOX 754
LEESPORT PA
19533
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-5707
  • Fax: 610-926-8352
Mailing address:
  • Phone: 610-926-5707
  • Fax: 610-926-8352

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: GREGORY C TUKE
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 610-926-5707