Provider Demographics
NPI:1689624884
Name:MUHLENBERG PRIMARY CARE
Entity Type:Organization
Organization Name:MUHLENBERG PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-868-6880
Mailing Address - Street 1:1650 VALLEY CENTER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2344
Mailing Address - Country:US
Mailing Address - Phone:484-884-4436
Mailing Address - Fax:484-884-4444
Practice Address - Street 1:2649 SCHOENERSVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7326
Practice Address - Country:US
Practice Address - Phone:610-868-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016256240001Medicaid
PACC4916OtherRAILROAD MEDICARE
PA814261OtherHIGHMARK BLUE SHIELD
PA02315600OtherCAPITAL BLUE CROSS
PA814261OtherAMERIHEALTH (IBC)
PA464025OtherAETNA
PA1503647OtherGATEWAY HEALTH PLAN
PA20008470OtherAMERIHEALTH MERCY
PA814261OtherKEYSTONE CENTRAL
PAE1CMOtherGEISINGER HEALTH PLAN
PA0016256240001Medicaid