1720061831 NPI number — LANCASTER GASTROENTEROLOGY PROCEDURE CENTER LLC

Table of content: (NPI 1720061831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720061831 NPI number — LANCASTER GASTROENTEROLOGY PROCEDURE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANCASTER GASTROENTEROLOGY PROCEDURE CENTER LLC
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:
LANCASTER GASTROENTEROLOGY PROCEDURE CENTER
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:
1720061831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2112 HARRISBURG PIKE
Provider Second Line Business Mailing Address:
SUITE 323
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17601-2644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-544-3569
Provider Business Mailing Address Fax Number:
717-544-3570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2112 HARRISBURG PIKE
Provider Second Line Business Practice Location Address:
SUITE 323
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-544-3569
Provider Business Practice Location Address Fax Number:
717-544-3570
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOLDEN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF MANAGER OF LLC
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QE0800X , with the licence number:  17211501 , 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: 1019852560001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00068382 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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