Provider Demographics
NPI:1598803736
Name:FAMILY MEDICAL CARE OF LAWRENCE COUNTY,INC
Entity type:Organization
Organization Name:FAMILY MEDICAL CARE OF LAWRENCE COUNTY,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QUALITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-946-3564
Mailing Address - Street 1:1995 MERCER NEW WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-2021
Mailing Address - Country:US
Mailing Address - Phone:724-946-3564
Mailing Address - Fax:724-946-2156
Practice Address - Street 1:1995 MERCER NEW WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-2021
Practice Address - Country:US
Practice Address - Phone:724-946-3564
Practice Address - Fax:724-946-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018116870001Medicaid
PA1018116870001Medicaid
PA1018116870001Medicaid