=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003222134
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DLP CONEMAUGH PHYSICIAN PRACTICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2014
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1060 LLOYD ST
-----------------------------------------------------
City | NANTY GLO
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15943-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-749-8624
-----------------------------------------------------
Fax | 814-749-8248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 SEVEN SPRINGS WAY
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-920-7000
-----------------------------------------------------
Fax | 615-920-8775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | CHARLOTTE LAWRENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-920-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------