Provider Demographics
NPI:1255512422
Name:FAMILY PRACTICE CENTER, P.C.
Entity type:Organization
Organization Name:FAMILY PRACTICE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAGERMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-837-2123
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:30 S FRONT ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113-2319
Practice Address - Country:US
Practice Address - Phone:717-939-9831
Practice Address - Fax:717-986-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02381800OtherKHP/CBC GROUP PROV NO.
PA0007932780001Medicaid
067807Medicare PIN
PA02381800OtherKHP/CBC GROUP PROV NO.