Mead Avenue Family Practice, INC.
Family Medicine in Corry, PA. Organization (NPI-2).
NPI number1124156765
StatusActive
Last updated in NPPESAug 22, 2007
Details
- NPI
- 1124156765
- Entity type
- Organization (NPI-2)
- Legal business name
- Mead Avenue Family Practice, INC.
- Organization subpart
- No
- Enumeration date
- Mar 2, 2007
- Last updated
- Aug 22, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | MD050434L | PA | Yes |
Practice location
1086 Mead AveCorry, PA 16407-8503
Phone 814-664-4542 · Fax 814-664-4556
Mailing address
1086 Mead AveCorry, PA 16407-8503
Phone 814-664-4542 · Fax 814-664-4556
Authorized official
Kurt E Lund
President
8146644542
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