Provider Demographics
NPI:1851330658
Name:IRWIN FAMILY CARE, PC
Entity Type:Organization
Organization Name:IRWIN FAMILY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAWDAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIKOULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-832-7887
Mailing Address - Street 1:905 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3683
Mailing Address - Country:US
Mailing Address - Phone:724-864-9595
Mailing Address - Fax:724-864-9860
Practice Address - Street 1:905 SPRUCE ST STE 201
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3683
Practice Address - Country:US
Practice Address - Phone:724-864-9595
Practice Address - Fax:724-864-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001263310002Medicaid
PACA3219OtherRAILROAD MEDICARE