Provider Demographics
NPI:1437455458
Name:WALNUT BOTTOM FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:WALNUT BOTTOM FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-960-0052
Mailing Address - Street 1:850 WALNUT BOTTOM RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3632
Mailing Address - Country:US
Mailing Address - Phone:717-960-0052
Mailing Address - Fax:717-960-0055
Practice Address - Street 1:850 WALNUT BOTTOM RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3632
Practice Address - Country:US
Practice Address - Phone:717-960-0052
Practice Address - Fax:717-960-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care