Provider Demographics
NPI:1942242631
Name:FAMILY PRACTICE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILL.IAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:CATENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-941-2323
Mailing Address - Street 1:907 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106
Mailing Address - Country:US
Mailing Address - Phone:724-941-2323
Mailing Address - Fax:724-941-2325
Practice Address - Street 1:907 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3215
Practice Address - Country:US
Practice Address - Phone:724-941-2323
Practice Address - Fax:724-941-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006436000001Medicaid
PA162252Medicare ID - Type Unspecified