Provider Demographics
NPI:1891245247
Name:MUNCY FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:MUNCY FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:570-546-8255
Mailing Address - Street 1:151 JOHN BRADY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PENNSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:17756-8401
Mailing Address - Country:US
Mailing Address - Phone:570-546-8255
Mailing Address - Fax:570-546-3668
Practice Address - Street 1:151 JOHN BRADY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:PENNSDALE
Practice Address - State:PA
Practice Address - Zip Code:17756-8401
Practice Address - Country:US
Practice Address - Phone:570-546-8255
Practice Address - Fax:570-546-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007523E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty