Provider Demographics
NPI:1942231683
Name:PATIENTS FIRST NORTHAMPTON MEDICAL CENTER P A
Entity Type:Organization
Organization Name:PATIENTS FIRST NORTHAMPTON MEDICAL CENTER P A
Other - Org Name:PATIENTS FIRST NORTHAMPTON MEDICAL CENTER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-668-3380
Mailing Address - Street 1:2907 KERRY FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6825
Mailing Address - Country:US
Mailing Address - Phone:850-668-3380
Mailing Address - Fax:850-668-3226
Practice Address - Street 1:2907 KERRY FOREST PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-6825
Practice Address - Country:US
Practice Address - Phone:850-668-3380
Practice Address - Fax:850-668-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCCR1657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253891100Medicaid
FLCL1424OtherRAILROAD MEDICARE PTAN
FL0771280001Medicare NSC
FL253891100Medicaid