=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932120292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARMBRISTER FAMILY MEDICAL SERVICES,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 05/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1014 S 5TH ST
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-3356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-433-0680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1014-1016 S 5TH STREET
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-3356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-433-0680
-----------------------------------------------------
Fax | 610-433-0681
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DORNA E ARMBRISTER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 610-433-0680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD418379
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------