Provider Demographics
NPI:1669434064
Name:DR BUB & ASSOC FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:DR BUB & ASSOC FAMILY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SLPG
Authorized Official - Prefix:DR
Authorized Official - First Name:ST LUKES
Authorized Official - Middle Name:
Authorized Official - Last Name:PHYSICIAN GROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-965-6048
Mailing Address - Street 1:623 E BROAD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6332
Mailing Address - Country:US
Mailing Address - Phone:610-965-6048
Mailing Address - Fax:
Practice Address - Street 1:619 DALTON ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-3031
Practice Address - Country:US
Practice Address - Phone:610-967-3646
Practice Address - Fax:610-966-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty