Ideal Wellness Family Practice, PC

Key facts

NPI

1639734213

Entity type

Organization (NPI type 2)

Primary specialty

Primary Care Clinic/Center 261QP2300X

Legal business name

IDEAL WELLNESS FAMILY PRACTICE, PC

Practice address

701 Leon Ave
Palmyra, PA 17078-3554

Phone

(717) 256-1820

NPI assigned

May 8, 2019

Organization subpart

No

Authorized official

Name

Dr. Jessica Amanda Orner, MD

Title

President

Phone

(609) 731-3478

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 5, 2019.

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1639734213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 BYLER CIR",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170424866",
            "telephone_number": "609-731-3478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 LEON AVE",
            "city": "PALMYRA",
            "state": "PA",
            "postal_code": "170783554",
            "telephone_number": "717-256-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL WELLNESS FAMILY PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "ORNER",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-731-3478",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Palmyra, PA · Primary Care Clinic/Center in Pennsylvania