Provider Demographics
NPI:1033164702
Name:SHIPPENSBURG FAMILY PRACTICE, LTD
Entity Type:Organization
Organization Name:SHIPPENSBURG FAMILY PRACTICE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGERY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-530-5117
Mailing Address - Street 1:46 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8219
Mailing Address - Country:US
Mailing Address - Phone:717-530-5117
Mailing Address - Fax:717-262-4593
Practice Address - Street 1:46 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8219
Practice Address - Country:US
Practice Address - Phone:717-530-5117
Practice Address - Fax:717-262-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care