1023116589 NPI number — GETTYSBURG MEDICAL CLINIC, INC.

Table of content: JOSHUA JOHN LAHAYE MD (NPI 1114621463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023116589 NPI number — GETTYSBURG MEDICAL CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GETTYSBURG MEDICAL CLINIC, INC.
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:
Provider Other Organization Name Type Code:
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:
1023116589
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:
143 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95340-4930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-725-2060
Provider Business Mailing Address Fax Number:
209-725-2072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-4930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-725-2060
Provider Business Practice Location Address Fax Number:
209-725-2072
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
WEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-244-6360

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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