Provider Demographics
NPI:1366472318
Name:EBENSBURG FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:EBENSBURG FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-471-6595
Mailing Address - Street 1:236 JAMESWAY RD
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4207
Mailing Address - Country:US
Mailing Address - Phone:814-471-6595
Mailing Address - Fax:
Practice Address - Street 1:236 JAMESWAY RD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4207
Practice Address - Country:US
Practice Address - Phone:814-471-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-09-03
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
PAP00146078OtherRRMC
PA1640177OtherBCBS
PA610852600OtherDEPT OF LABOR
PA0012105120004Medicaid
PA11064OtherGEISINGER
PA1539685OtherGATEWAY
PA157145OtherUNISON
PADC0689OtherRRMC
PA702426OtherUPMC
PA0012105120004Medicaid
PA084879Medicare PIN