1730153768 NPI number — THE MILTON S HERSHEY MEDICAL CENTER PHYSICIANS GROUP

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 1730153768 NPI number — THE MILTON S HERSHEY MEDICAL CENTER PHYSICIANS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MILTON S HERSHEY MEDICAL CENTER PHYSICIANS 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:
MSHMC DERMATOPATHOLOGY
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:
1730153768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 858
Provider Second Line Business Mailing Address:
MC A410
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-0858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-531-1159
Provider Business Mailing Address Fax Number:
717-531-7269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-243-1455
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MASSINI
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
717-531-8405

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007452910073 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".