Provider Demographics
NPI:1215927322
Name:FREDERICKSBURG COMMUNITY HEALTH CENTER PC
Entity type:Organization
Organization Name:FREDERICKSBURG COMMUNITY HEALTH CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:MR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-865-6644
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-0009
Mailing Address - Country:US
Mailing Address - Phone:717-865-6644
Mailing Address - Fax:717-865-7321
Practice Address - Street 1:120 S. TAN ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026
Practice Address - Country:US
Practice Address - Phone:717-865-6644
Practice Address - Fax:717-865-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1520462OtherGATEWAY
PA0018501090001Medicaid
PA02377200OtherBLUE CROSS
PACH6940OtherMEDICARE RAILROAD
PA1520462OtherGATEWAY