Provider Demographics
NPI:1750346441
Name:SCHUYLKILL VALLEY FAMILY PRACTICE PC
Entity type:Organization
Organization Name:SCHUYLKILL VALLEY FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-926-5707
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533
Mailing Address - Country:US
Mailing Address - Phone:610-926-5707
Mailing Address - Fax:610-926-8352
Practice Address - Street 1:5 S CENTRE AVENUE
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533
Practice Address - Country:US
Practice Address - Phone:610-926-5707
Practice Address - Fax:610-926-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA95986OtherHEALTH ASSURANCE AMERICA
PA0037OtherAETNA
PA02329200OtherCAPITAL BLUE CROSS
PACF7991OtherPALMETTO RAILROAD MEDICAR
PA0019244180001Medicaid
PA100278OtherAMERIHEALTH MERCY
PA129142OtherHIGHMARK BLUE SHIELD
PA129142Medicare ID - Type Unspecified