Provider Demographics
NPI:1265773410
Name:MEDICAL ATHLETIC CENTER, LLC
Entity type:Organization
Organization Name:MEDICAL ATHLETIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-767-4151
Mailing Address - Street 1:2320 STONEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9710
Mailing Address - Country:US
Mailing Address - Phone:717-767-4151
Mailing Address - Fax:717-767-2023
Practice Address - Street 1:1785 LOUCKS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9710
Practice Address - Country:US
Practice Address - Phone:717-767-4151
Practice Address - Fax:717-767-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAMD06549L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty