Provider Demographics
NPI:1710995188
Name:SWEET FAMILY PRACTICE
Entity Type:Organization
Organization Name:SWEET FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:MAYBELLE
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-268-6400
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854-0341
Mailing Address - Country:US
Mailing Address - Phone:570-268-6400
Mailing Address - Fax:570-268-6401
Practice Address - Street 1:GOLDEN MILE BOX 341
Practice Address - Street 2:
Practice Address - City:WYSOX
Practice Address - State:PA
Practice Address - Zip Code:18854-0341
Practice Address - Country:US
Practice Address - Phone:570-268-6400
Practice Address - Fax:570-268-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061835L207Q00000X, 207V00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096515Medicare PIN