=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164507927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANK L. CONLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 07/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 924 HURON AVE
-----------------------------------------------------
City | RENOVO
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17764-1191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-923-2700
-----------------------------------------------------
Fax | 570-923-0824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 924 HURON AVE
-----------------------------------------------------
City | RENOVO
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17764-1191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-923-2700
-----------------------------------------------------
Fax | 570-923-0824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FRANK L. CONLY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 570-923-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------