Provider Demographics
NPI:1245263839
Name:FORD CITY FAMILY PRACTICE
Entity type:Organization
Organization Name:FORD CITY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:724-763-9200
Mailing Address - Street 1:432 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1003
Mailing Address - Country:US
Mailing Address - Phone:724-763-9200
Mailing Address - Fax:724-763-9235
Practice Address - Street 1:432 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1003
Practice Address - Country:US
Practice Address - Phone:724-763-9200
Practice Address - Fax:724-763-9235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009820-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001810730-0003Medicaid
PA001810730-0003Medicaid