Provider Demographics
NPI:1407096910
Name:FAMILY PRACTICE OF JEFFERSONVILLE, LLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE OF JEFFERSONVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:YARMARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-277-9040
Mailing Address - Street 1:190 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1385
Mailing Address - Country:US
Mailing Address - Phone:610-277-9040
Mailing Address - Fax:610-277-7890
Practice Address - Street 1:190 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 155
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1385
Practice Address - Country:US
Practice Address - Phone:610-277-9040
Practice Address - Fax:610-277-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006142L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty