Provider Demographics
NPI:1982873253
Name:MONT ALTO FAMILY PRACTICE
Entity type:Organization
Organization Name:MONT ALTO FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-749-3181
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:MONT ALTO
Mailing Address - State:PA
Mailing Address - Zip Code:17237-0369
Mailing Address - Country:US
Mailing Address - Phone:717-749-3181
Mailing Address - Fax:717-749-3191
Practice Address - Street 1:6155 ANTHONY HWY
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-9718
Practice Address - Country:US
Practice Address - Phone:717-749-3181
Practice Address - Fax:717-749-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA393853Medicare PIN
PA561418Medicare PIN