Provider Demographics
NPI:1437358777
Name:SPRING ROAD FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:SPRING ROAD FAMILY PRACTICE, INC.
Other - Org Name:SPRING ROAD FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-226-9529
Mailing Address - Street 1:1921 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1157
Mailing Address - Country:US
Mailing Address - Phone:717-243-5444
Mailing Address - Fax:717-243-8578
Practice Address - Street 1:1921 SPRING RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-1157
Practice Address - Country:US
Practice Address - Phone:717-243-5444
Practice Address - Fax:717-243-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2015-01-27
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
PA0019522250006Medicaid