Provider Demographics
NPI:1558490086
Name:SEYMOUR FAMILY MEDICINE
Entity Type:Organization
Organization Name:SEYMOUR FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-944-3569
Mailing Address - Street 1:2529 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1912
Mailing Address - Country:US
Mailing Address - Phone:814-944-3569
Mailing Address - Fax:814-944-8201
Practice Address - Street 1:2529 BROAD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1912
Practice Address - Country:US
Practice Address - Phone:814-944-3569
Practice Address - Fax:814-944-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001630558OtherHIGHMARK BLUE SHIELD
PA0019504360002Medicaid
PA085501Medicare ID - Type UnspecifiedMDCR
PA0019504360002Medicaid