MEDICARE: THREE SPRINGS FAMILY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10970	OTHER	PA	HEALTH AMERICA
2	02610900	OTHER	PA	CAPITAL BLUE CROSS
3	1511086	OTHER	PA	GATEWAY HEALTH PLAN

General Provider Information

NPI Number	:	1295795862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE SPRINGS FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	303 N BALTIMORE AVE
Second Line	:
City	:	MT HOLLY SPRINGS
State	:	PA
Zip	:	17065-1607
Country	:	US
Telephone Number	:	717-486-8550
Fax Number	:	717-486-3022

Provider Business Practice Location Address
First Line	:	303 N BALTIMORE AVE
Second Line	:
City	:	MT HOLLY SPRINGS
State	:	PA
Zip	:	17065-1607
Country	:	US
Telephone Number	:	717-486-8550
Fax Number	:	717-486-3022

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. MICHAEL O. DANIELS
Credential	:	M.D.
Telephone Number	:	717-486-8550

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/22/2020

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Directions to “THREE SPRINGS FAMILY PRACTICE ” Practice Location

Language	Start Address	Practice Location

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