Provider Demographics
NPI:1417082900
Name:EMMITSBURG OSTEOPATHIC PRIMARY CARE CENTER, INC.
Entity Type:Organization
Organization Name:EMMITSBURG OSTEOPATHIC PRIMARY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KREMPEL-PORTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-447-3310
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:121-123 W. MAIN STREET, REAR
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-1219
Mailing Address - Country:US
Mailing Address - Phone:301-447-3310
Mailing Address - Fax:301-447-5851
Practice Address - Street 1:121 W. MAIN STREET, REAR
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-1219
Practice Address - Country:US
Practice Address - Phone:301-447-3310
Practice Address - Fax:301-447-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0044037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD331811700Medicaid
PA16021650008Medicaid
PA16021650008Medicaid