Provider Demographics
NPI:1861479313
Name:HOUCKS ROAD FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:HOUCKS ROAD FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-545-9625
Mailing Address - Street 1:100 SOUTH HOUCKS ROAD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-2827
Mailing Address - Country:US
Mailing Address - Phone:717-545-9625
Mailing Address - Fax:717-545-4773
Practice Address - Street 1:100 SOUTH HOUCKS ROAD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-2827
Practice Address - Country:US
Practice Address - Phone:717-545-9625
Practice Address - Fax:717-545-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006314L207Q00000X
PATP006126B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001208748Medicaid
PA608243Medicare PIN
PA001208748Medicaid