| Mead Avenue Family Practice, Inc. | |
|
1086 Mead Ave Corry PA 16407-8503 | |
| (814) 664-4542 | |
| (814) 664-4556 |
| Full Name | Mead Avenue Family Practice, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1086 Mead Ave, Corry, Pennsylvania |
| Authorized Official Name and Position | Kurt E Lund (PRESIDENT) |
| Authorized Official Contact | 8146644542 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mead Avenue Family Practice, Inc. 1086 Mead Ave Corry PA 16407-8503 Ph: (814) 664-4542 | Mead Avenue Family Practice, Inc. 1086 Mead Ave Corry PA 16407-8503 Ph: (814) 664-4542 |
| NPI Number | 1124156765 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 08/22/2007 |
| Medicare PECOS PAC ID | 8123123668 |
|---|---|
| Medicare Enrollment ID | O20070412000065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124156765 | NPI | - | NPPES |
| 1019472820001 | Medicaid | PA | |
| DF6619 | Other | PA | RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD050434L (Pennsylvania) | Primary |
| Provider Name | Kurt E Lund |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578535985 PECOS PAC ID: 3870563570 Enrollment ID: I20040729000866 |
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