1982790622 NPI number — WELLSPAN MEDICAL GROUP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982790622 NPI number — WELLSPAN MEDICAL GROUP

Employer Identification Number (EIN):

Provider Organization Name:

WELLSPAN 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 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:

1982790622

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/11/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

601 MEMORY LN

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

YORK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17402-2231

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-851-6120

Provider Business Mailing Address Fax Number:

717-409-6223

Provider First Line Business Practice Location Address:

25 MONUMENT RD STE 295

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

YORK

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17403-5049

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-851-6120

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/04/2006

Authorized Official Last Name:

SWEITZER

Authorized Official First Name:

JENNIFER

Authorized Official Middle Name:

Authorized Official Title or Position:

DIRECTOR PATIENT FINANCIAL SERVICES

Authorized Official Telephone Number:

717-851-6838

• Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 02320900 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1519852 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
• Identifier: 342T . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 85260 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0539341002 . This is a "AMERIHEALTH 65PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1142775 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 800174 . This is a "JOHN HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: CA3246 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1007721360240 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7669877 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: KX03 . This is a "MD CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 265025 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".