1831168228 NPI number — LOCK HAVEN MEDICAL PROFESSIONALS, PC

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 1831168228 NPI number — LOCK HAVEN MEDICAL PROFESSIONALS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOCK HAVEN MEDICAL PROFESSIONALS, PC
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:
COMMUNITY MEDICAL CARE ASSOCIATES
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:
1831168228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
337 ARCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNBURY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17801-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-286-0303
Provider Business Mailing Address Fax Number:
570-286-5794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 ARCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNBURY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17801-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-286-0303
Provider Business Practice Location Address Fax Number:
570-286-5794
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOME
Authorized Official First Name:
GARY
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
GROUP VP
Authorized Official Telephone Number:
570-286-0303

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)





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