Provider Demographics
NPI:1235197104
Name:HANOVER FAMILY PRACTICE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HANOVER FAMILY PRACTICE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-0774
Mailing Address - Street 1:111 PENN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1929
Mailing Address - Country:US
Mailing Address - Phone:717-632-4449
Mailing Address - Fax:
Practice Address - Street 1:111 PENN ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1929
Practice Address - Country:US
Practice Address - Phone:717-632-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA182943OtherHEALTH AMERICA/ ASSURANCE
PA5337129OtherAETNA
PA827916OtherBLUE SHIELD
PA0859603000OtherINDEPENDANCE BLUE CROSS
PA02307000OtherBLUE CROSS
PA238893OtherMAMSI
PA1007518240013Medicaid
PACC6198OtherPALMETTO
PA1520197OtherGATEWAY
PA1007518240013Medicaid
PA=========OtherPHCS
PA=========OtherGREA T W EST
PA182943OtherHEALTH AMERICA/ ASSURANCE
PA=========OtherSCP
PA827916OtherBLUE SHIELD