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NPI Code Detail

MEDICARE: ANNVILLE FAMILY MEDICINE, PC

MEDICARE: ANNVILLE FAMILY MEDICINE, PC
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477532653
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANNVILLE FAMILY MEDICINE, PC
Provider Business Mailing Address
First Line : 475 N WEABER ST
Second Line :
City : ANNVILLE
State : PA
Zip : 17003-1104
Country : US
Telephone Number : 717-867-4671
Fax Number :
Provider Business Practice Location Address
First Line : 475 N WEABER ST
Second Line :
City : ANNVILLE
State : PA
Zip : 17003-1104
Country : US
Telephone Number : 717-867-4671
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : VELMA A NICKLISS
Credential :
Telephone Number : 717-867-4671
Provider Enumeration Date : 01/16/2006
Last Update Date : 12/03/2009

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Directions to “ANNVILLE FAMILY MEDICINE, PC ” Practice Location

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