Provider Demographics
NPI:1588640379
Name:FAMILY PRACTICE OF HONEY BROOK, PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE OF HONEY BROOK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-273-2429
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:471 PEQUEA AVE
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-0460
Mailing Address - Country:US
Mailing Address - Phone:610-273-2429
Mailing Address - Fax:610-273-3798
Practice Address - Street 1:471 PEQUEA AVE
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344
Practice Address - Country:US
Practice Address - Phone:610-273-2429
Practice Address - Fax:610-273-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011543700007Medicaid
PA0026510001OtherKEYSTONE GROUP #
PA0011543700007Medicaid