Healthcare Provider Details

I. General information

NPI: 1386609014
Provider Name (Legal Business Name): LEBANON VALLEY FAMILY MEDICINE, INC
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

1400 S FORGE RD
PALMYRA PA
17078-9519
US

IV. Provider business mailing address

1400 S FORGE RD
PALMYRA PA
17078-9519
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-1301
  • Fax:
Mailing address:
  • Phone: 717-838-1301
  • Fax:

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: SHIRLEY L DAILEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 717-838-1301