1912988114 NPI number — LANCASTER GENERAL MEDICAL GROUP

Table of content: (NPI 1912988114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912988114 NPI number — LANCASTER GENERAL MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANCASTER GENERAL MEDICAL 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:
PENN MEDICINE LANCASTER GENERAL HEALTH PHYSICIANS INTERNAL MEDICINE
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:
1912988114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 HARRISBURG PIKE STE 100
Provider Second Line Business Mailing Address:
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:
717-544-3191
Provider Business Mailing Address Fax Number:
717-544-3637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 HARRISBURG PIKE STE 100
Provider Second Line Business Practice Location Address:
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:
717-544-3191
Provider Business Practice Location Address Fax Number:
717-544-3637
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FINANCIAL SERVICES
Authorized Official Telephone Number:
717-544-5010

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 406992 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5720505 . This is a "AETNA NON-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2117135 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 502924 . This is a "AETNA CAP OFFICE#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007327490100 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519062 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: S1QA . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CG4751 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03092900 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com