1558659219 NPI number — PHYSICIAN SPECIALISTS OF NORTHERN LANCASTER COUNTY

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 1558659219 NPI number — PHYSICIAN SPECIALISTS OF NORTHERN LANCASTER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN SPECIALISTS OF NORTHERN LANCASTER COUNTY
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:
Provider Other Organization Name Type Code:
6
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:
1558659219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4131 OREGON PIKE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17522-9550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-859-5161
Provider Business Mailing Address Fax Number:
717-859-5169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 NEW HOLLAND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17602-2288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-291-0700
Provider Business Practice Location Address Fax Number:
717-291-9634
Provider Enumeration Date:
07/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NOLL
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
717-859-5161

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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