Provider Demographics
NPI:1851794937
Name:FORE YOUR HEALTH FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:FORE YOUR HEALTH FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:T
Authorized Official - Last Name:WIRTHS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-236-3993
Mailing Address - Street 1:1541 CURWENSVILLE GRAMPIAN HWY
Mailing Address - Street 2:
Mailing Address - City:GRAMPIAN
Mailing Address - State:PA
Mailing Address - Zip Code:16838-7924
Mailing Address - Country:US
Mailing Address - Phone:814-236-3993
Mailing Address - Fax:814-236-3957
Practice Address - Street 1:1541 CURWENSVILLE GRAMPIAN HWY
Practice Address - Street 2:
Practice Address - City:GRAMPIAN
Practice Address - State:PA
Practice Address - Zip Code:16838-7924
Practice Address - Country:US
Practice Address - Phone:814-236-3993
Practice Address - Fax:814-236-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009145L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty