Provider Demographics
NPI:1275729576
Name:HUMMELSTOWN FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:HUMMELSTOWN FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ENDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-566-8786
Mailing Address - Street 1:215 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-1420
Mailing Address - Country:US
Mailing Address - Phone:717-566-8786
Mailing Address - Fax:717-566-8702
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-1420
Practice Address - Country:US
Practice Address - Phone:717-566-8786
Practice Address - Fax:717-566-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S006156L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01117545Medicaid
PAB33566Medicare UPIN