Provider Demographics
NPI:1710177126
Name:FAMILY PRACTICE PROFESSIONAL CO.
Entity Type:Organization
Organization Name:FAMILY PRACTICE PROFESSIONAL CO.
Other - Org Name:LANGHORNE FAMILY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VASHTI
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-750-1361
Mailing Address - Street 1:668 WOODBOURNE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1820
Mailing Address - Country:US
Mailing Address - Phone:215-750-1361
Mailing Address - Fax:215-752-0651
Practice Address - Street 1:668 WOODBOURNE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1820
Practice Address - Country:US
Practice Address - Phone:215-750-1361
Practice Address - Fax:215-752-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization