Provider Demographics
NPI:1033322466
Name:FAMILY PRACTICE CENTER, PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DARRUP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-837-5889
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:270 SUSQUEHANNA VALLEY MALL DR STE 200
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9115
Practice Address - Country:US
Practice Address - Phone:570-884-7920
Practice Address - Fax:570-884-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020650291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39D0657424OtherCLIA
GA690004734OtherMCRR PIN
PA300377Medicare PIN