Provider Demographics
NPI:1861442089
Name:KAMBIC FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:KAMBIC FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAMBIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-939-4593
Mailing Address - Street 1:PO BOX 7649
Mailing Address - Street 2:
Mailing Address - City:STEELTON
Mailing Address - State:PA
Mailing Address - Zip Code:17113-0649
Mailing Address - Country:US
Mailing Address - Phone:717-939-4593
Mailing Address - Fax:717-939-4668
Practice Address - Street 1:483 N FRONT ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113-2124
Practice Address - Country:US
Practice Address - Phone:717-939-4593
Practice Address - Fax:717-939-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005053L207Q00000X
PAVP004679B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02623500OtherCAPITAL BLUE CROSS
PA001751019OtherHIGHMARK BLUE SHIELD
PACN9580OtherRR MEDICARE
PA1007504510004Medicaid
PA1487616991Medicare PIN
PAH63235Medicare UPIN
PA001751019OtherHIGHMARK BLUE SHIELD