NPIMap

Organization Active NPI

Lebanon Valley Family Medicine, Inc

  • Family Medicine Physician
  • Palmyra, PA
National Provider Identifier
1386609014
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LEBANON VALLEY FAMILY MEDICINE, INC
Practice address
1400 S Forge Rd
Palmyra, PA 17078-9519
Phone
(717) 838-1301
NPI assigned
Apr 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Shirley L Dailey
Title
Business Manager
Phone
(717) 838-1301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1400 S Forge Rd
Palmyra, PA 17078-9519

Mailing address

1400 S Forge Rd
Palmyra, PA 17078-9519
Phone (717) 838-1301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040306000058 PA Part B Supplier - Clinic/Group Practice 7214825876 Receives reassigned benefits from 9 practitioners
Practice locations: Annville, PA; Palmyra, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386609014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S FORGE RD",
            "city": "PALMYRA",
            "state": "PA",
            "postal_code": "170789519",
            "telephone_number": "717-838-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S FORGE RD",
            "city": "PALMYRA",
            "state": "PA",
            "postal_code": "170789519",
            "telephone_number": "717-838-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON VALLEY FAMILY MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAILEY",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "717-838-1301"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmyra, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.