Provider Demographics
NPI:1992863682
Name:FAMILY WELLNESS CENTER INC.
Entity type:Organization
Organization Name:FAMILY WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-845-1145
Mailing Address - Street 1:1181 STATE ROUTE 356
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-2033
Mailing Address - Country:US
Mailing Address - Phone:724-845-1145
Mailing Address - Fax:724-845-1679
Practice Address - Street 1:1181 STATE ROUTE 356
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-2033
Practice Address - Country:US
Practice Address - Phone:724-845-1145
Practice Address - Fax:724-845-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006017L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1992816615OtherINDIVIDUAL NPI NUMBER
PA$$$$$$$$$OtherSOCIAL SECURITY NUMBER
PA170528719OtherSOCIAL SECURITY NUMBER