1841637733 NPI number — EPHRATA COMMUNITY HOSPITAL

Table of content: (NPI 1841637733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841637733 NPI number — EPHRATA COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPHRATA COMMUNITY HOSPITAL
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 EPHRATA COMMUNITY HOSPITAL WOUND HEALING & HYPERBARIC SERVICE
Provider Other Organization Name Type Code:
5
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:
1841637733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
785 5TH AVE STE 3
Provider Second Line Business Mailing Address:
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:
717-709-6529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 MARTIN AVE
Provider Second Line Business Practice Location Address:
SUITE 355
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17522-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-738-6674
Provider Business Practice Location Address Fax Number:
717-721-5938
Provider Enumeration Date:
05/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CITRO
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP & PRESIDENT
Authorized Official Telephone Number:
717-738-6407

Provider Taxonomy Codes

  • Taxonomy code: 2083P0011X , with the licence number:  310301 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007464680006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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