Mead Avenue Family Practice, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD050434L Issued in PA

Legal business name

MEAD AVENUE FAMILY PRACTICE, INC.

Practice address

1086 Mead Ave
Corry, PA 16407-8503

Phone

(814) 664-4542

Fax

(814) 664-4556

NPI assigned

Mar 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kurt E Lund, M.D.

Title

President

Phone

(814) 664-4542

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1124156765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 MEAD AVE",
            "city": "CORRY",
            "state": "PA",
            "postal_code": "164078503",
            "telephone_number": "814-664-4542",
            "fax_number": "814-664-4556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 MEAD AVE",
            "city": "CORRY",
            "state": "PA",
            "postal_code": "164078503",
            "telephone_number": "814-664-4542",
            "fax_number": "814-664-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEAD AVENUE FAMILY PRACTICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "LUND",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-664-4542",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD050434L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019472820001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "DF6619",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.