Provider Demographics
NPI:1598803736
Name:FAMILY MEDICAL CARE OF LAWRENCE COUNTY,INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CARE OF LAWRENCE COUNTY,INC
Other - Org Name:FAMILY MEDICAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHESS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:724-946-3564
Mailing Address - Street 1:150 N NEW CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1019
Mailing Address - Country:US
Mailing Address - Phone:724-946-3564
Mailing Address - Fax:724-946-2156
Practice Address - Street 1:150 N NEW CASTLE ST
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1019
Practice Address - Country:US
Practice Address - Phone:724-946-3564
Practice Address - Fax:724-946-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-11-05
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
PA001742959OtherHIGHMARK
PA1018116870001Medicaid
PA1018116870001Medicaid