| North East Family Practice | |
|
115 E Main St North East PA 16428-1330 | |
| (814) 725-8774 | |
| (814) 725-2391 |
| Full Name | North East Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 115 E Main St, North East, Pennsylvania |
| Authorized Official Name and Position | John E Dudzinski (OWNER PHYSICIAN) |
| Authorized Official Contact | 8147258774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North East Family Practice 115 E Main St North East PA 16428-1330 Ph: (814) 725-8774 | North East Family Practice 115 E Main St North East PA 16428-1330 Ph: (814) 725-8774 |
| NPI Number | 1154490480 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 09/04/2008 |
| Medicare PECOS PAC ID | 7416971775 |
|---|---|
| Medicare Enrollment ID | O20060125000707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154490480 | NPI | - | NPPES |
| 1014723860001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS006274L (Pennsylvania) | Primary |
| 207Q00000X | Family Medicine | OS012532 (Pennsylvania) | Secondary |
| Provider Name | Philip Charles Devore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366409062 PECOS PAC ID: 7719920057 Enrollment ID: I20050607000899 |
| Provider Name | John E Dudzinski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174580070 PECOS PAC ID: 0042254526 Enrollment ID: I20060125000748 |
Vineyard Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2060 N Pearl Street, North East, PA 16428 Phone: 814-877-7711 Fax: 814-877-7715 |