Healthcare Provider Details

I. General information

NPI: 1861442089
Provider Name (Legal Business Name): KAMBIC FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N FRONT ST
STEELTON PA
17113-2124
US

IV. Provider business mailing address

PO BOX 7649
STEELTON PA
17113-0649
US

V. Phone/Fax

Practice location:
  • Phone: 717-939-4593
  • Fax: 717-939-4668
Mailing address:
  • Phone: 717-939-4593
  • Fax: 717-939-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberVP004679B
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS005053L
License Number StatePA

VIII. Authorized Official

Name: DR. DANIEL M KAMBIC
Title or Position: PRESIDENT
Credential: D.O.
Phone: 717-939-4593