1053329979 NPI number — NORTHERN LANCASTER COUNTY MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053329979 NPI number — NORTHERN LANCASTER COUNTY MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN LANCASTER COUNTY MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTERNAL MEDICINE ASSOCIATES OF EPHRATA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053329979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 398
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17508-0398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-859-2038
Provider Business Mailing Address Fax Number:
717-859-2803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 PLEASANTVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-733-6518
Provider Business Practice Location Address Fax Number:
717-733-8613
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALIZIA
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP NORTHERN LANC CO MEDICAL GROUP
Authorized Official Telephone Number:
717-738-2280

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013977730015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1746271 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DD6938 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com