Provider Demographics
NPI:1538192315
Name:FAMILY MEDICINE OF LIONVILLE LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE OF LIONVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRIEVEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-363-7559
Mailing Address - Street 1:PO BOX 481RTE 113
Mailing Address - Street 2:
Mailing Address - City:LIONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19353-0481
Mailing Address - Country:US
Mailing Address - Phone:610-363-7303
Mailing Address - Fax:610-524-4718
Practice Address - Street 1:529 WEST UWCHLAN AVENUE
Practice Address - Street 2:
Practice Address - City:LIONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19353-0481
Practice Address - Country:US
Practice Address - Phone:610-363-7303
Practice Address - Fax:610-524-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002581L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D77418Medicare UPIN
093411Medicare PIN
PA093411Medicare PIN