Provider Demographics
NPI:1780808519
Name:DANVILLE FAMILY PRACTICE
Entity type:Organization
Organization Name:DANVILLE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-275-3789
Mailing Address - Street 1:1410 BLOOM RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8501
Mailing Address - Country:US
Mailing Address - Phone:570-275-3789
Mailing Address - Fax:
Practice Address - Street 1:1410 BLOOM RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8501
Practice Address - Country:US
Practice Address - Phone:570-275-3789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019417E261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1928457OtherHIGHMARK PROVIDER NUMBER