Provider Demographics
NPI:1902859101
Name:KEYSTONE FAMILY MEDICINE ASSOCIATES, P. C.
Entity Type:Organization
Organization Name:KEYSTONE FAMILY MEDICINE ASSOCIATES, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAYNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-339-5754
Mailing Address - Street 1:28 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-2106
Mailing Address - Country:US
Mailing Address - Phone:570-339-5754
Mailing Address - Fax:570-339-3820
Practice Address - Street 1:28 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2106
Practice Address - Country:US
Practice Address - Phone:570-339-5754
Practice Address - Fax:570-339-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005323-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016251410001Medicaid
PA0016251410001Medicaid
PA092899Medicare PIN