Provider Demographics
NPI:1619050085
Name:KALATA FAMILY PRACTICE
Entity Type:Organization
Organization Name:KALATA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KALATA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-454-1851
Mailing Address - Street 1:404 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1204
Mailing Address - Country:US
Mailing Address - Phone:814-454-1851
Mailing Address - Fax:814-455-8313
Practice Address - Street 1:404 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1204
Practice Address - Country:US
Practice Address - Phone:814-454-1851
Practice Address - Fax:814-455-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006320L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005713500001Medicaid
PA675253OtherKEYSTONE
PA675253OtherKEYSTONE
PA041266Medicare ID - Type Unspecified