Provider Demographics
NPI:1164507927
Name:FRANK L. CONLY
Entity Type:Organization
Organization Name:FRANK L. CONLY
Other - Org Name:FAMILY PRACTICE OF RENOVO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-923-2700
Mailing Address - Street 1:924 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:RENOVO
Mailing Address - State:PA
Mailing Address - Zip Code:17764-1191
Mailing Address - Country:US
Mailing Address - Phone:570-923-2700
Mailing Address - Fax:570-923-0824
Practice Address - Street 1:924 HURON AVE
Practice Address - Street 2:
Practice Address - City:RENOVO
Practice Address - State:PA
Practice Address - Zip Code:17764-1191
Practice Address - Country:US
Practice Address - Phone:570-923-2700
Practice Address - Fax:570-923-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002954OtherFIRST PRIORITY HEALTH
PA000946170004Medicaid
PA188455OtherBLUE SHIELD
PADD5539OtherRAILROAD MEDICARE
PA1204OtherGEISINGER HEALTH PLAN
PA002954OtherFIRST PRIORITY HEALTH