Provider Demographics
NPI:1073552568
Name:FAMILY HEALTH ASSOCIATES OF LEWISTOWN
Entity Type:Organization
Organization Name:FAMILY HEALTH ASSOCIATES OF LEWISTOWN
Other - Org Name:FAMILY HEALTH ASSOCIATES PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FHA OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-242-7103
Mailing Address - Street 1:400 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1167
Mailing Address - Country:US
Mailing Address - Phone:717-242-7722
Mailing Address - Fax:717-242-7712
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-242-7722
Practice Address - Fax:717-242-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875369Medicare ID - Type UnspecifiedGROUP NUMBER