Provider Demographics
NPI:1043267578
Name:BUTLER FAMILY PRACTICE
Entity Type:Organization
Organization Name:BUTLER FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-287-8500
Mailing Address - Street 1:116 WOODY DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5692
Mailing Address - Country:US
Mailing Address - Phone:724-287-8500
Mailing Address - Fax:
Practice Address - Street 1:116 WOODY DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5692
Practice Address - Country:US
Practice Address - Phone:724-287-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA029584E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014914040002Medicaid
B35527Medicare UPIN
PA0014914040002Medicaid