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General NPI Number Information
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NPI Number | 1104482587
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Entity Type | Organization
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Legal Business Name | LIEB FAMILY PRACTICE INC
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Dates
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Enumeration Date | 05/12/2019
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Last Update Date | 02/01/2020
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Provider Practice Location Address
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Address Line | 188 INDUSTRIAL PARK RD STE B
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City | EBENSBURG
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State | PA
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Zip | 15931-4125
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Country | US
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Telephone | 814-419-8211
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Fax | 814-846-5945
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Provider Business Mailing Address
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Address Line | 203 FOREST LN
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City | CARROLLTOWN
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State | PA
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Zip | 15722-8819
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Country | US
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Telephone | 814-659-7309
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN LIEB
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Credential | DO
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Telephone | 814-419-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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