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General NPI Number Information
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NPI Number | 1356374037
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Entity Type | Organization
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Legal Business Name | YELLOW BREECHES FAMILY PRACTICE CENTER
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 1358 LUTZTOWN RD
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City | BOILING SPRINGS
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State | PA
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Zip | 17007-9302
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Country | US
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Telephone | 717-258-3274
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Fax | 717-258-0311
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Provider Business Mailing Address
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Address Line | 1358 LUTZTOWN RD
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City | BOILING SPRINGS
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State | PA
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Zip | 17007-9302
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Country | US
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Telephone | 717-258-3274
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Fax | 717-258-0311
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DONALD J KOVACS
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Credential | MD
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Telephone | 717-258-3274
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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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