Provider Demographics
NPI:1316686702
Name:SOVEREIGN FAMILY PRACTICE INC
Entity type:Organization
Organization Name:SOVEREIGN FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ODONNELL MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-226-1181
Mailing Address - Street 1:7150 HAMILTON BLVD UNIT 400
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-9734
Mailing Address - Country:US
Mailing Address - Phone:610-351-1555
Mailing Address - Fax:610-351-1445
Practice Address - Street 1:7150 HAMILTON BLVD UNIT 400
Practice Address - Street 2:
Practice Address - City:TREXLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18087-9734
Practice Address - Country:US
Practice Address - Phone:610-351-1555
Practice Address - Fax:610-351-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care