Provider Demographics
NPI:1124087184
Name:DALLAS FAMILY PRACTICE, L.L.C.
Entity type:Organization
Organization Name:DALLAS FAMILY PRACTICE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-675-2111
Mailing Address - Street 1:16 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1136
Mailing Address - Country:US
Mailing Address - Phone:570-675-2111
Mailing Address - Fax:570-675-6545
Practice Address - Street 1:16 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1136
Practice Address - Country:US
Practice Address - Phone:570-675-2111
Practice Address - Fax:570-675-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001823531-0002Medicaid
PAE160OtherGEISINGER HEALTH PLAN
PA78201OtherMED PLUS
PA78201OtherMED PLUS
PAX54883Medicare UPIN