Provider Demographics
NPI:1831505981
Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:188 INDUSTRIAL PARK RD
Mailing Address - Street 2:STE. B
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4125
Mailing Address - Country:US
Mailing Address - Phone:814-471-9005
Mailing Address - Fax:814-471-9007
Practice Address - Street 1:188 INDUSTRIAL PARK RD
Practice Address - Street 2:STE. B
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4125
Practice Address - Country:US
Practice Address - Phone:814-471-9005
Practice Address - Fax:814-471-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty