Provider Demographics
NPI:1003254343
Name:SCOTTDALE FAMILY HEALTH
Entity Type:Organization
Organization Name:SCOTTDALE FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-797-0014
Mailing Address - Street 1:103 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-2047
Mailing Address - Country:US
Mailing Address - Phone:724-797-0014
Mailing Address - Fax:
Practice Address - Street 1:103 MARKET ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-2047
Practice Address - Country:US
Practice Address - Phone:724-797-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty