Provider Demographics
NPI:1639201023
Name:GREENCASTLE FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:GREENCASTLE FAMILY PRACTICE, PC
Other - Org Name:GREENCASTLE FAMILY PRACTICE, COUNSELING AND PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:223-465-2025
Mailing Address - Street 1:50 EASTERN AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1100
Mailing Address - Country:US
Mailing Address - Phone:717-597-0095
Mailing Address - Fax:717-597-3147
Practice Address - Street 1:50 EASTERN AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1100
Practice Address - Country:US
Practice Address - Phone:717-597-0095
Practice Address - Fax:717-597-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000234101YM0800X
PAPS008907L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50001005OtherCAPITAL BLUE CROSS GROUP
PA706786OtherHIGHMARK BLUE SHIELD