Provider Demographics
NPI:1871828830
Name:SHAMOKIN DAM FAMILY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:SHAMOKIN DAM FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REIBSCHIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-743-6191
Mailing Address - Street 1:99 BALDWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-9514
Mailing Address - Country:US
Mailing Address - Phone:570-743-6191
Mailing Address - Fax:570-743-6191
Practice Address - Street 1:99 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9514
Practice Address - Country:US
Practice Address - Phone:570-743-6191
Practice Address - Fax:570-743-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty