Provider Demographics
NPI:1730238494
Name:FAMILY DOCTOR, INC
Entity type:Organization
Organization Name:FAMILY DOCTOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HEID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-966-5549
Mailing Address - Street 1:1040 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1952
Mailing Address - Country:US
Mailing Address - Phone:610-966-5549
Mailing Address - Fax:610-967-0204
Practice Address - Street 1:1040 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1952
Practice Address - Country:US
Practice Address - Phone:610-966-5549
Practice Address - Fax:610-967-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02349800OtherCAPITAL BLUE CROSS
PA875361OtherPA. BLUE SHIELD
PAE1BBOtherGEISINGER HEALTH PLAN
PAE1BBOtherGEISINGER HEALTH PLAN