Provider Demographics
NPI:1518362243
Name:DECKER FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:DECKER FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-337-1144
Mailing Address - Street 1:901 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3434
Mailing Address - Country:US
Mailing Address - Phone:814-337-1144
Mailing Address - Fax:
Practice Address - Street 1:901 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3434
Practice Address - Country:US
Practice Address - Phone:814-337-1144
Practice Address - Fax:814-337-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010482L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty