Provider Demographics
NPI:1205851136
Name:POCONO FAMILY HEALTH, LLC
Entity Type:Organization
Organization Name:POCONO FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LEVELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-421-5003
Mailing Address - Street 1:505 INDEPENDENCE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7916
Mailing Address - Country:US
Mailing Address - Phone:570-421-5003
Mailing Address - Fax:
Practice Address - Street 1:505 INDEPENDENCE RD
Practice Address - Street 2:SUITE C
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7916
Practice Address - Country:US
Practice Address - Phone:570-421-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID#
PA066702Medicare ID - Type UnspecifiedMEDICARE GROUP #