Provider Demographics
NPI:1407252349
Name:MODERN FAMILY HEALTH, INC.
Entity Type:Organization
Organization Name:MODERN FAMILY HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-864-2888
Mailing Address - Street 1:1214 BETHEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHICKSHINNY
Mailing Address - State:PA
Mailing Address - Zip Code:18655-3749
Mailing Address - Country:US
Mailing Address - Phone:570-864-2888
Mailing Address - Fax:570-864-2866
Practice Address - Street 1:1214 BETHEL HILL RD
Practice Address - Street 2:
Practice Address - City:SHICKSHINNY
Practice Address - State:PA
Practice Address - Zip Code:18655-3749
Practice Address - Country:US
Practice Address - Phone:570-864-2888
Practice Address - Fax:570-864-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty