Provider Demographics
NPI:1104482587
Name:LIEB FAMILY PRACTICE INC
Entity type:Organization
Organization Name:LIEB FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-419-8211
Mailing Address - Street 1:203 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-8819
Mailing Address - Country:US
Mailing Address - Phone:814-659-7309
Mailing Address - Fax:
Practice Address - Street 1:188 INDUSTRIAL PARK RD STE B
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4125
Practice Address - Country:US
Practice Address - Phone:814-419-8211
Practice Address - Fax:814-846-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-12
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty