1760430342 NPI number — THE MILTON S. HERSHEY MEDICAL CENTER PHYSICIANS GROUP

Table of content: (NPI 1760430342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760430342 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 MEDICAL NUTRITIONAL THERAPY
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:
1760430342
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:
PO BOX 854
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:
17033-0854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-531-5995
Provider Business Mailing Address Fax Number:
717-531-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 SCHOOLHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17057-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-948-5180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALEY
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
717-531-8810

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007452910081 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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