1235446188 NPI number — SUMMIT PHYSICIAN SERVICES

Table of content: (NPI 1235446188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235446188 NPI number — SUMMIT PHYSICIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT PHYSICIAN SERVICES
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:
WELLSPAN ENDOCRINOLOGY
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:
1235446188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
785 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
CHAMBERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17201-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-263-9555
Provider Business Mailing Address Fax Number:
717-217-4218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 ST PAUL DR STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-217-6820
Provider Business Practice Location Address Fax Number:
717-217-6942
Provider Enumeration Date:
09/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HINCKLE
Authorized Official First Name:
LISSA
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
SENIOR VP OF PHYSICIAN SERVICES
Authorized Official Telephone Number:
717-267-4839

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0205X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007307260118 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260130 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260144 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260166 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260172 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260041 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260049 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260132 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007307260142 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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