Provider Demographics
NPI:1073581690
Name:MUNCY FAMILY PRACTICE
Entity Type:Organization
Organization Name:MUNCY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:570-546-8255
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-0209
Mailing Address - Country:US
Mailing Address - Phone:570-546-8255
Mailing Address - Fax:570-546-3668
Practice Address - Street 1:151 JOHN BRADY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:PENNSDALE
Practice Address - State:PA
Practice Address - Zip Code:17756-8425
Practice Address - Country:US
Practice Address - Phone:570-546-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033946E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC33025Medicare UPIN