1780799577 NPI number — NORTHERN LANCASTER COUNTY MEDICAL GROUP

Table of content: (NPI 1780799577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780799577 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:
HARVEST DRIVE FAMILY PRACTICE
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:
1780799577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
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:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3469 HARVEST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GORDONVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17529-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-768-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALIZIA
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT NLCMG
Authorized Official Telephone Number:
717-738-0851

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1893629 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1013977730020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD6938 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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