Provider Demographics
NPI:1164939138
Name:PORTERSVILLE FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:PORTERSVILLE FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILHITE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:724-368-4118
Mailing Address - Street 1:120 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:PORTERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16051-2419
Mailing Address - Country:US
Mailing Address - Phone:724-368-4118
Mailing Address - Fax:724-368-4117
Practice Address - Street 1:105 ADAMS LANE
Practice Address - Street 2:
Practice Address - City:PORTERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16051
Practice Address - Country:US
Practice Address - Phone:724-368-4118
Practice Address - Fax:724-368-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty