Provider Demographics
NPI:1942266028
Name:SALLAVANTI & COTTER FAMILY MEDICINE LTD
Entity Type:Organization
Organization Name:SALLAVANTI & COTTER FAMILY MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKEY-GARBUTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:717-560-6470
Mailing Address - Street 1:2207 OREGON PIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4606
Mailing Address - Country:US
Mailing Address - Phone:717-560-6470
Mailing Address - Fax:717-560-6472
Practice Address - Street 1:2207 OREGON PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4606
Practice Address - Country:US
Practice Address - Phone:717-560-6470
Practice Address - Fax:717-560-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037971Medicare PIN