Provider Demographics
NPI:1023670189
Name:AVALON PRIMARY CARE, PC
Entity type:Organization
Organization Name:AVALON PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-899-8113
Mailing Address - Street 1:2160 LINCOLN HWY E STE 1-A4
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1150
Mailing Address - Country:US
Mailing Address - Phone:717-899-8113
Mailing Address - Fax:717-617-2476
Practice Address - Street 1:2160 LINCOLN HWY E STE 1-A4
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-1150
Practice Address - Country:US
Practice Address - Phone:717-899-8113
Practice Address - Fax:717-617-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care