Provider Demographics
NPI:1164536611
Name:SOUTHERN FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:SOUTHERN FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:PEDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-227-3800
Mailing Address - Street 1:16312 MOUNT AIRY RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1623
Mailing Address - Country:US
Mailing Address - Phone:717-227-3800
Mailing Address - Fax:717-227-3802
Practice Address - Street 1:16312 MOUNT AIRY RD
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1623
Practice Address - Country:US
Practice Address - Phone:717-227-3800
Practice Address - Fax:717-227-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASO1624336OtherHIGHMARK BLUE SHIELD
PA959ASOOtherCARE FIRST
PA50036273OtherCAPITAL BLUE CROSS
PA959ASOOtherCARE FIRST